TY - JOUR
T1 - Incidence of T3a up-staging and survival after partial nephrectomy
T2 - Size-stratified rates and implications for prognosis
AU - Srivastava, Arnav
AU - Patel, Hiten D.
AU - Joice, Gregory A.
AU - Semerjian, Alice
AU - Gorin, Michael A.
AU - Johnson, Michael H.
AU - Allaf, Mohamad E.
AU - Pierorazio, Phillip M.
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/1
Y1 - 2018/1
N2 - Background The use of partial nephrectomy (PN) to treat renal cell carcinoma has grown to include larger, more complex tumors. Such tumors are more likely to be up-staged to pT3a and generate controversy regarding the oncologic safety of PN. We aimed to estimate the proportion of patients up-staged to T3a disease after PN, stratified by clinical stage, and characterize their survival. Methods From 1998 to 2013, pT1-pT3aN0M0 kidney cancer patients undergoing PN or radical nephrectomy (RN) were identified from the Surveillance Epidemiology and End Results registries. Cox proportional hazards models compared cancer-specific (CSS) and overall survival (OS) for PN patients with pT1a, pT1b, and pT2 disease to stratified, up-staged pT3a patients undergoing PN. Also, we compared PN patients with up-staged pT3a disease to RN patients with pT3a disease. Results From the 28,854 patients undergoing PN, the estimated proportion up-staged to pT3a was 4.2%, 9.5%, and 19.5% for cT1a, cT1b, and cT2, respectively. OS was worse for tumors up-staged from cT1a to pT3a, but not for cT1b or cT2 tumors. Up-staged pT3a tumors across all stage strata demonstrated worse CSS, with worse survival for larger tumors. Analysis revealed no difference in OS or CSS for up-staged pT3a PN patients compared to pT3a RN patients. Conclusions A greater proportion of patients experience T3a up-staging after PN with increasing initial T stage. Up-staged pT3a patients have worse CSS across all clinical tumor stages after PN. However, our results do not demonstrate that patients up-staged after PN have compromised oncologic outcomes compared to all-comers with pT3a disease receiving RN.
AB - Background The use of partial nephrectomy (PN) to treat renal cell carcinoma has grown to include larger, more complex tumors. Such tumors are more likely to be up-staged to pT3a and generate controversy regarding the oncologic safety of PN. We aimed to estimate the proportion of patients up-staged to T3a disease after PN, stratified by clinical stage, and characterize their survival. Methods From 1998 to 2013, pT1-pT3aN0M0 kidney cancer patients undergoing PN or radical nephrectomy (RN) were identified from the Surveillance Epidemiology and End Results registries. Cox proportional hazards models compared cancer-specific (CSS) and overall survival (OS) for PN patients with pT1a, pT1b, and pT2 disease to stratified, up-staged pT3a patients undergoing PN. Also, we compared PN patients with up-staged pT3a disease to RN patients with pT3a disease. Results From the 28,854 patients undergoing PN, the estimated proportion up-staged to pT3a was 4.2%, 9.5%, and 19.5% for cT1a, cT1b, and cT2, respectively. OS was worse for tumors up-staged from cT1a to pT3a, but not for cT1b or cT2 tumors. Up-staged pT3a tumors across all stage strata demonstrated worse CSS, with worse survival for larger tumors. Analysis revealed no difference in OS or CSS for up-staged pT3a PN patients compared to pT3a RN patients. Conclusions A greater proportion of patients experience T3a up-staging after PN with increasing initial T stage. Up-staged pT3a patients have worse CSS across all clinical tumor stages after PN. However, our results do not demonstrate that patients up-staged after PN have compromised oncologic outcomes compared to all-comers with pT3a disease receiving RN.
KW - Partial nephrectomy
KW - Renal cell carcinoma
KW - Survival
KW - Up-staging
UR - http://www.scopus.com/inward/record.url?scp=85030475909&partnerID=8YFLogxK
U2 - 10.1016/j.urolonc.2017.09.005
DO - 10.1016/j.urolonc.2017.09.005
M3 - Article
C2 - 28970053
AN - SCOPUS:85030475909
SN - 1078-1439
VL - 36
SP - 12.e7-12.e13
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 1
ER -