Adverse pathologic features impact survival outcomes for small renal masses following nephrectomy Journal Article
| Authors: | Khaleel, S.; Truong, H.; Jiang, S.; K-Lee, P.; Davelman, B.; Gordon, D.; Benfante, N.; Arora, A.; Ostrovnaya, I.; Tickoo, S.; Coleman, J.; Hakimi, A. A.; Russo, P. |
| Article Title: | Adverse pathologic features impact survival outcomes for small renal masses following nephrectomy |
| Abstract: | Purpose: While most small renal masses (SRM) < 4 cm have an excellent prognosis following resection, the impact of adverse T3a pathologic features on oncologic outcomes of SRMs remains unclear. We sought to compare clinical outcomes for surgically resected pT3a versus pT1a SRMs at our institution. Materials and methods: We retrospectively reviewed records of patients who underwent radical or partial nephrectomy (RN, PN) for renal tumors <4 cm at our institution between 2010 and 2020. We compared features and outcomes of pT3a vs pT1a SRMs. Continuous and categorical variables were compared using Student's t and Pearson's chi-squared tests, respectively. Postoperative outcomes of interest including overall, cancer-specific, and recurrence-free survival (OS, CSS, and RFS) were analyzed using Kaplan-Meier method, Cox proportional hazard regression, and competing risk analysis. Analyses were performed using R statistical package (R Foundation, v4.0). Results: We identified 1,837 patients with malignant SRMs. Predictors of postoperative pT3a upstaging included higher renal score, larger tumor size, and presence of radiologic features concerning for T3a disease (odds ratio [OR] = 5.45, 95% confidence interval [CI] 3.92–7.59, P < 0.001). On univariable modeling, pT3a SRMs had higher positive margin rates (9.6% vs 4.1%, P < 0.001), worse OS (hazard ratio [HR] = 2.9, 95% CI 1.6-5.3, P = 0.002), RFS (HR 9.32, 95% CI 2-40.1, P = 0.003), and CSS (HR = 3.6, 95% CI 1.5–8.2, P = 0.003). On multivariable modeling, pT3a status remained associated with worse RFS (HR = 2.7, 95% CI 1.04–7, P = 0.04), but not OS (HR 1.6, 95% CI = 0.83–3.1, P = 0.2); multivariable modeling was deferred for CSS due to low event rates. Conclusions: Adverse T3a pathologic features portend worse outcomes for SRMs, highlighting the crucial role of pre-operative planning and case selection. These patients have relatively poor prognosis, and should be monitored more closely and counseled for consideration of adjuvant therapy or clinical trials. © 2023 Elsevier Inc. |
| Keywords: | adult; cancer survival; controlled study; human tissue; aged; middle aged; retrospective studies; major clinical study; overall survival; clinical feature; postoperative period; cancer staging; follow up; cancer incidence; neoplasm staging; cancer grading; preoperative evaluation; tumor volume; cohort analysis; pathology; medical record review; retrospective study; histology; renal cell carcinoma; kidney neoplasms; nephrectomy; cancer mortality; body mass; adverse outcome; partial nephrectomy; radical nephrectomy; kidney tumor; carcinoma, renal cell; active surveillance; cancer specific survival; scoring system; perioperative period; recurrence free survival; clear cell renal cell carcinoma; surgical margin; clinical outcome; papillary renal cell carcinoma; procedures; chromophobe renal cell carcinoma; local recurrence free survival; distant metastasis free survival; small renal mass; charlson comorbidity index; humans; human; male; female; article; adverse pathology; t3 stage; t3a stage; arterial based complexity score |
| Journal Title: | Urologic Oncology: Seminars and Original Investigations |
| Volume: | 41 |
| Issue: | 9 |
| ISSN: | 1078-1439 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2023-09-01 |
| Start Page: | 391.e5 |
| End Page: | 391.e11 |
| Language: | English |
| DOI: | 10.1016/j.urolonc.2023.06.010 |
| PUBMED: | 37423816 |
| PROVIDER: | scopus |
| PMCID: | PMC11042782 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Paul Russo -- Source: Scopus |
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