Skip to main content

Advertisement

SpringerLink
Log in

Pathological upstaging of clinical T1 renal cell carcinoma: an analysis of 115,835 patients from National Cancer Data Base, 2004–2013

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Clinical staging is vital for treatment decision-making by renal cell carcinoma (RCC) patients. Some RCCs clinically appear T1 on CT, but are actually T3a due to extension into fat or renal vein, causing the tumor to be pathologically upstaged. The objective of this study to determine the rate, survival, and predictors of RCC upstaging, for patients with cT1 disease treated surgically.

Methods

Using the National Cancer Data Base Participant User File for RCC from 2004 to 2013, we selected AJCC cT1 patients, who underwent surgical resection and whose AJCC pathological T stage (pT) was available. Upstaging was characterized dichotomously—overall (any pT > T1) and pT3a-specific upstaging. Patient and tumor characteristics of those upstaged and not were compared using Chi-squared analyses. Multivariable logistic regression was used to analyze predictors of upstaging, and Cox proportional hazards regression was used to estimate overall survival hazards ratios.

Results

Overall upstaging (pT > T1) was observed in 8252 (7.1%) patients, and T3a-specific upstaging was observed in 3380 (5.4%) patients. Patients who were older, male, and had comorbidities, and tumors that were cT1b, underwent RN, and had high Fuhrman grade were at a higher risk of pathological upstaging. Upstaging led to a 40% increased risk of death compared to patients who were not upstaged.

Conclusion

The rate of upstaging is not negligible (5–7% of the time), negatively impacts survival, and various patient and tumor characteristics can be used to predict upstaging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hüsch T, Reiter MA, Mager R, Kurosch M, Haferkamp A (2012) Treatment of locally advanced renal cell. Carcinoma. https://doi.org/10.1016/j.eursup.2012.04.003

    Google Scholar 

  2. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66(1):7–30. https://doi.org/10.3322/caac.21332

    Article  PubMed  Google Scholar 

  3. Novick AC, Campbell SC, Belldegrun A et al Guideline for management of the clinical stage 1 renal mass AUA staff: Chapter 1: management of the clinical stage 1 renal mass: diagnosis and treatment recommendations. https://www.auanet.org/common/pdf/education/clinical-guidance/Renal-Mass.pdf. Accessed 21 March 2017

  4. Nayak JG, Patel P, Saarela O et al (2016) Pathological upstaging of clinical T1 to pathological T3a renal cell carcinoma: a multi-institutional analysis of short-term outcomes. Urology 94:154–160. https://doi.org/10.1016/j.urology.2016.03.029

    Article  PubMed  Google Scholar 

  5. Ramaswamy K, Kheterpal E, Pham H et al (2015) Significance of pathologic T3a upstaging in clinical T1 renal masses undergoing nephrectomy. Clin Genitourin Cancer 13(4):344–349. https://doi.org/10.1016/j.clgc.2015.01.001

    Article  PubMed  Google Scholar 

  6. Gorin MA, Ball MW, Pierorazio PM et al (2013) Outcomes and predictors of clinical T1 to pathological T3a tumor up-staging after robotic partial nephrectomy: a multi-institutional analysis. J Urol 190(5):1907–1911. https://doi.org/10.1016/j.juro.2013.06.014

    Article  PubMed  Google Scholar 

  7. Mouracade P, Kara O, Dagenais J et al (2017) Perioperative morbidity, oncological outcomes and predictors of pT3a upstaging for patients undergoing partial nephrectomy for cT1 tumors. World J Urol. https://doi.org/10.1007/s00345-017-2004-x

    PubMed  Google Scholar 

  8. Tay MHW, Thamboo TP, Wu FMW et al (2014) High RENAL Nephrometry scores are associated with pathologic upstaging of clinical T1 renal-cell carcinomas in radical nephrectomy specimens: implications for nephron-sparing surgery. J Endourol 28(9):1138–1142. https://doi.org/10.1089/end.2014.0123

    Article  PubMed  Google Scholar 

  9. Shah PH, Moreira DM, Patel VR et al (2017) Partial nephrectomy is associated with higher risk of relapse compared with radical nephrectomy for clinical stage T1 renal cell carcinoma pathologically upstaged to T3a. J Urol. https://doi.org/10.1016/j.juro.2017.03.012

    Google Scholar 

  10. Weight CJ, Lythgoe C, Unnikrishnan R, Lane BR, Campbell SC, Fergany AF (2011) Partial nephrectomy does not compromise survival in patients with pathologic upstaging to pT2/pT3 or high-grade renal tumors compared with radical nephrectomy. Urology 77(5):1142–1146. https://doi.org/10.1016/j.urology.2010.11.058

    Article  PubMed  Google Scholar 

  11. Roberts W, Bhayani S, Allaf M, Chan T, Kavoussi L, Jarrett T (2005) Pathological stage does not alter the prognosis for renal lesions determined to be stage T1 by computerized tomography. J Urol 173(3):713–715. https://doi.org/10.1097/01.ju.0000153638.15018.58

    Article  PubMed  Google Scholar 

  12. Moch H, Artibani W, Delahunt B et al (2009) Reassessing the current UICC/AJCC TNM staging for renal cell carcinoma. Eur Urol. https://doi.org/10.1016/j.eururo.2009.06.036

    Google Scholar 

  13. Lam JS, Klatte T, Breda A (2009) Staging of renal cell carcinoma: current concepts. Indian J Urol 25(4):446–454. https://doi.org/10.4103/0970-1591.57906

    Article  PubMed  PubMed Central  Google Scholar 

  14. Survival rates for kidney cancer by stage. http://www.cancer.org/cancer/kidneycancer/detailedguide/kidney-cancer-adult-survival-rates

  15. Jeong S, Kim JK, Park J et al (2016) Pathological T3a upstaging of clinical T1 renal cell carcinoma: outcomes according to surgical technique and predictors of upstaging. PLoS ONE 11(11):e0166183. https://doi.org/10.1371/journal.pone.0166183

    Article  PubMed  PubMed Central  Google Scholar 

  16. National Cancer Database. https://www.facs.org/quality-programs/cancer/ncdb. Accessed 1 April 2017

  17. American College of Surgeons. Participant User Files|National Cancer Data Base—Data Dictionary PUF 2014. http://ncdbpuf.facs.org/About. Accessed 1 April 2017

  18. Bilimoria KY, Stewart AK, Winchester DP, Ko CY (2008) The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 15(3):683–690. https://doi.org/10.1245/s10434-007-9747-3

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bernhard JC, Patard JJ, Bigot P, Suer E et al (2015) From clinically localized to pT3a renal cell carcinoma: What are the predictive factors of unexpected pathologic upstaging? Eur Urol Suppl 14:e727–e727a. https://doi.org/10.1016/S1569-9056(15)60719-9

    Article  Google Scholar 

  20. Ficarra V, Artibani W (2006) Staging system of renal cell carcinoma: current issues. Eur Urol Suppl. https://doi.org/10.1016/j.eururo.2005.11.018

    Google Scholar 

  21. Winchester DP, Stewart AK, Phillips JL, Ward EE (2010) The National Cancer Data Base: past, present, and future. Ann Surg Oncol 17(1):4–7. https://doi.org/10.1245/s10434-009-0771-3

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 2263E Weiskotten Hall, 750 East Adams St., Syracuse, NY, 13210, USA

    Amanda Ghanie, Margaret K. Formica, Dongliang Wang & Telisa Stewart

  2. Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA

    Margaret K. Formica, Gennady Bratslavsky & Telisa Stewart

Authors
  1. Amanda Ghanie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Margaret K. Formica
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dongliang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gennady Bratslavsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Telisa Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margaret K. Formica.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghanie, A., Formica, M.K., Wang, D. et al. Pathological upstaging of clinical T1 renal cell carcinoma: an analysis of 115,835 patients from National Cancer Data Base, 2004–2013. Int Urol Nephrol 50, 237–245 (2018). https://doi.org/10.1007/s11255-017-1768-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-017-1768-7

Keywords

Search

Navigation