title: Pathological Upstaging of Clinical T1 to Pathological T3a Renal Cell Carcinoma: A Multi-institutional Analysis of Short-term Outcomes.
abstract: OBJECTIVE
  To determine the oncological impact of pathological upstaging among patients with clinical T1 (cT1) disease treated by partial nephrectomy or radical nephrectomy.
  
  
  METHODS
  The Canadian Kidney Cancer Information System comprises a prospectively maintained multi-institutional database for patients with renal cell carcinoma. Nonmetastatic, cT1 renal cell carcinoma cases were evaluated. Upstaging was defined as pathological T3a disease. Multivariate Cox regression analysis identified predictors for recurrence (local recurrence and/or metastatic disease) whereas logistic regression identified predictors of pathological upstaging. Kaplan-Meier methods estimated survival.
  
  
  RESULTS
  Of 1448 eligible cT1 patients, upstaging was observed in 134 (9%). One thousand fifty-eight (73%) were treated by partial nephrectomy. After a median follow-up of 23 months, the 3-year recurrence-free survival was 76% in upstaged patients compared with 93% in those not upstaged (P < .001). Controlling for age, gender, year of surgery, histology, tumor size, surgical approach, and margin status, pathological upstaging was independently associated with disease recurrence (hazard ratio 2.03, 95% confidence interval [CI] 1.12-3.68). Increasing age (odds ratio [OR] 1.02, 95% CI 1.00-1.05), Fuhrman grade (OR 2.47, 95% CI 1.47-4.14), and tumor size (OR 1.16, 95% CI 1.00-1.36) were independently associated with a risk of pathological upstaging.
  
  
  CONCLUSIONS
  Pathological upstaging confers a negative prognosis and highlights the importance of accurate clinical staging. A number of factors have been identified, including some attainable by renal biopsy, which may predict upstaging and provide valuable adjunct information to inform risk stratification and management decisions among patients with cT1 renal masses.
authors.affiliation: Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Urology, University of Washington, Seattle, WA.
authors.forename: Jasmir G
authors.initials: JG
authors.lastname: Nayak
authors.affiliation: Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Premal
authors.initials: P
authors.lastname: Patel
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Olli
authors.initials: O
authors.lastname: Saarela
authors.affiliation: Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Division of Urology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Anil
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Department of Urology, University of Toronto, Canada.
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
authors.affiliation: Division of Urology, McGill University, Montreal, Quebec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Tanguay
authors.affiliation: Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Rendon
authors.affiliation: Division of Urology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Moore
authors.affiliation: Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Black
authors.affiliation: Centre hospitalier universitaire de Québec, Quebec City, Quebec, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Lacombe
authors.affiliation: The Ottawa Hospital Research Institute, Division of Urology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Breau
authors.affiliation: Southern Alberta Institute of Urology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jun
authors.initials: J
authors.lastname: Kawakami
authors.affiliation: Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: ddrachenberg@sbgh.mb.ca.
authors.forename: Darrel E
authors.initials: DE
authors.lastname: Drachenberg
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy; D013997:Time Factors; D016896:Treatment Outcome