title: Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma: Outcomes According to Surgical Technique and Predictors of Upstaging.
abstract: OBJECTIVE
  To evaluate the prognosis of pT3a upstaging from cT1 renal cell carcinoma, and to compare the outcomes of partial or radical nephrectomy in cases of pT3a upstaging.
  
  
  METHODS
  We reviewed the records of patients who underwent partial or radical nephrectomy for cT1 at our center between January 2001 and October 2013. We compared the 2-year recurrence-free survivals for cases with pT1 or pT3a upstaging, and for partial or radical nephrectomy in cases with pT3a upstaging. Clinicopathological parameters were analyzed in univariate and multivariate analyses to evaluate their associations with upstaging.
  
  
  RESULTS
  Among the 1,009 eligible patients, 987 patients were included in the analysis. The mean follow-up was 48.5 ± 27.8 months in whole patients. The 2-year recurrence-free survival was worse in the pT3a upstaging group, compared to the pT1 group (87.3% vs. 98.7%; p < 0.001). Partial nephrectomy and radical nephrectomy had no significant difference in 2-year recurrence-free survivals (91.9% vs. 83.7%; p = 0.251). The multivariate analysis revealed that upstaging was associated with old age, cT1b stage, clinical symptoms, and a high Fuhrman grade.
  
  
  CONCLUSIONS
  Pathological T3a upstaging of cT1 renal cell carcinoma was associated with a poorer prognosis, compared to pT1 disease. However, the surgical technique (radical or partial nephrectomy) did not affect the recurrence rate. Therefore, clinicians should select the treatment method based on the clinical stage, and consider the pathological stage during the follow-up.
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seung-Hwan
authors.initials: SH
authors.lastname: Jeong
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jung Kwon
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Juhyun
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ho Joon
authors.initials: HJ
authors.lastname: Jeon
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Min Young
authors.initials: MY
authors.lastname: Yoon
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000379:methods; D009392:Nephrectomy / Q000379:methods; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies