title: Perioperative morbidity, oncological outcomes and predictors of pT3a upstaging for patients undergoing partial nephrectomy for cT1 tumors.
abstract: OBJECTIVE
  To evaluate perioperative morbidity, oncological outcome and predictors of pT3a upstaging after partial nephrectomy (PN).
  
  
  METHODS
  Retrospective study of 1042 patients who underwent PN for cT1N0M0 renal cell carcinoma between 2007 and 2015. A total of 113 cT1 patients were upstaged to pT3a, while 929 were staged as pT1. Demographic, perioperative and pathological variables were reviewed. We compared the clinico-pathological characteristics, perioperative morbidity and oncological outcomes between pT3a and pT1 groups. Multivariate regression evaluates variables associated with T3a upstaging. Recurrence-free survival (RFS) and overall survival analyses were performed. Survival curves were compared using log-rank test.
  
  
  RESULTS
  The pT3a tumors were high complexity tumors (median RENAL score 8 vs. 7, p < 0.01), higher hilar (h) location (27.5 vs. 14.8%, p < 0.01), higher grade (57.5 vs. 38.2%, p < 0.01), and higher positive surgical margins (18.6 vs. 5.8%, p < 0.01. Patients with pT3a had a higher estimated blood loss, transfusion rate, ischemia time and overall complications, though there were no differences in median e-GFR decline and major (Grade III-V) complications. Five-year RFS was 78.5% for pT3a group vs. 94.6% for pT1 group (log-rank p < 0.01). Male gender (OR 2.2, p < 0.01), and R.E.N.A.L. score (OR 2.3, p = 0.01) were preoperative predictors of upstaging. We acknowledge limitations in our study, most are inherent problems of retrospective studies.
  
  
  CONCLUSIONS
  Perioperative morbidity, after partial nephrectomy, is acceptable in cT1/pT3 tumors in comparison to cT1/pT1; however, upstaged patients had a worse oncological outcome. cT1/pT3a tumors are associated with adverse clinico-pathological features. Preoperative risk predictors of upstaging were higher R.E.N.A.L. score and male gender.
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.
authors.forename: Pascal
authors.initials: P
authors.lastname: Mouracade
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.
authors.forename: Onder
authors.initials: O
authors.lastname: Kara
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.
authors.forename: Julien
authors.initials: J
authors.lastname: Dagenais
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Maurice
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Nelson
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA.
authors.forename: Ercan
authors.initials: E
authors.lastname: Malkoc
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave., Q10-1, Cleveland, OH, 44195, USA. kaoukj@ccf.org.
authors.forename: J H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D050377:Cold Ischemia / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy; D010359:Patient Readmission / Q000706:statistics & numerical data; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology*; D051437:Renal Insufficiency / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000706:statistics & numerical data
keywords: Partial nephrectomy; Recurrence; Survival; Upstage; pT3a