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Oncological outcomes after partial vs radical nephrectomy in renal cell carcinomas of ≤7 cm with presumed renal sinus fat invasion on preoperative imaging

Authors
 Kyo Chul Koo  ;  Jong Chan Kim  ;  Kang Su Cho  ;  Young Deuk Choi  ;  Sung Joon Hong  ;  Seung Choul Yang  ;  Won Sik Ham 
Citation
 BJU INTERNATIONAL, Vol.117(1) : 87-93, 2016 
Journal Title
 BJU INTERNATIONAL 
ISSN
 1464-4096 
Issue Date
2016
MeSH
Adipose Tissue/pathology ; Adult ; Aged ; Carcinoma, Renal Cell*/epidemiology ; Carcinoma, Renal Cell*/mortality ; Carcinoma, Renal Cell*/pathology ; Carcinoma, Renal Cell*/surgery ; Diagnostic Imaging ; Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Kidney Neoplasms*/epidemiology ; Kidney Neoplasms*/mortality ; Kidney Neoplasms*/pathology ; Kidney Neoplasms*/surgery ; Male ; Middle Aged ; Nephrectomy*/adverse effects ; Nephrectomy*/methods ; Nephrectomy*/statistics & numerical data ; Recurrence ; Retrospective Studies ; Treatment Outcome
Keywords
carcinoma ; diagnostic imaging ; nephrectomy ; renal cell ; treatment outcome
Abstract
OBJECTIVES: To compare oncological outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for renal tumours of ≤7 cm in which preoperative imaging reveals potential renal sinus fat invasion (cT3a), as RN is preferred for these tumours due to concerns about high tumour stage. PATIENTS AND METHODS: Among 1137 nephrectomies performed for renal tumours of ≤7 cm from January 2005 to August 2012, 401 solitary cT3a renal cell carcinomas (RCCs) without metastases were analysed. Classification as cT3a included only renal sinus fat invasion, as there were no tumours with suspected perinephric fat invasion. Multivariate models were used to evaluate predictors of recurrence-free survival (RFS) and cancer-specific survival (CSS). RESULTS: There were 34 RCCs (8.5%) with unexpected perinephric fat invasion, but only 77 RCCs (19.2%) were staged as pT3a. During the median follow-up of 43.0 months, recurrence occurred in seven (6.7%) PN cases and 25 (8.4%) RN cases. Six recurred PN cases had positive surgical margins (PSMs). The two cohorts showed equal oncological outcomes for 5-year RFS and CSS. Multivariate analyses showed PSM, pathological T stage, sarcomatoid dedifferentiation, and type of surgery as significant predictors of recurrence. Older age, pathological T stage, and sarcomatoid dedifferentiation were significant predictors of cancer-specific mortality. CONCLUSIONS: Renal tumours of ≤7 cm with presumed renal sinus fat invasion were mostly pT1. PN conferred equivalent oncological outcomes to RN. If clear surgical margins can be obtained, PN should be considered for these tumours, as patients may benefit from renal function preservation.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/bju.12893/abstract
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DOI
10.1111/bju.12893
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Koo, Kyo Chul(구교철) ORCID logo https://orcid.org/0000-0001-7303-6256
Kim, Jong Chan(김종찬) ORCID logo https://orcid.org/0000-0002-0022-6689
Yang, Seung Choul(양승철)
Cho, Kang Su(조강수) ORCID logo https://orcid.org/0000-0002-3500-8833
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
Hong, Sung Joon(홍성준) ORCID logo https://orcid.org/0000-0001-9869-065X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/145511
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