TY - JOUR
T1 - Upstaging to pT3a disease in patients undergoing robotic partial nephrectomy for cT1 kidney cancer
T2 - Outcomes and predictors from a multi-institutional dataset
AU - Veccia, Alessandro
AU - Antonelli, Alessandro
AU - Minervini, Andrea
AU - Mottrie, Alexandre
AU - Dell'Oglio, Paolo
AU - Ashrafi, Akbar N.
AU - Larcher, Alessandro
AU - Eun, Daniel
AU - Bradshaw, Aaron
AU - Amparore, Daniele
AU - Brassetti, Aldo
AU - Hampton, Lance J.
AU - Simeone, Claudio
AU - Mari, Andrea
AU - Carini, Marco
AU - De Naeyer, Geert
AU - Yang, Kevin
AU - Capitanio, Umberto
AU - Simone, Giuseppe
AU - Porpiglia, Francesco
AU - Derweesh, Ithaar
AU - Aron, Monish
AU - Autorino, Riccardo
N1 - Funding Information:
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Dr. Veccia is an Italian Society of Urology-American Urological Association (SIU-AUA) research fellow. Funding for his fellowship is also provided by the VCU Urology Research Fund.
Publisher Copyright:
© 2019 Elsevier Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/4
Y1 - 2020/4
N2 - Objectives: Surgically treated clinical T1 (cT1) kidney cancer has in general a good prognosis, but there is a risk of upstaging that can potentially jeopardize the oncological outcomes after partial nephrectomy (PN). Aim of this study is to analyze the outcomes of robot-assisted PN (RAPN) for cT1 kidney cancer upstaged to pT3a, and to identify predictors of upstaging. Material and methods: The study cohort included 1,640 cT1 patients who underwent RAPN between 2005 and 2018 at 10 academic institutions. Multivariate logistic regression model was used to assess the predictors of upstaging. Kaplan-Meier curves and multivariable Cox regression analyses were used to evaluate recurrence-free survival and overall survival. Results: Overall, 74 (4%) were upstaged cases (cT1/pT3a). Upstaged patients presented larger renal tumors (3.1 vs. 2.4 cm; P = 0.001), and higher R.E.N.A.L. score (8.0 vs. 6.0; P = 0.004). cT1/pT3a group had higher rate of intraoperative complications (5 vs. 1% P = 0.032), higher pathological tumor size (3.2 vs. 2.5 cm; P < 0.001), higher rate of Fuhrman grade ≥3 (32 vs. 17%; P = 0.002), and higher number of sarcomatoid differentiation (4 vs. 1%; P = 0.008). Chronic kidney disease (CKD) stage ≥3 (OR: 2.54; P < 0.014), and clinical tumor size (OR: 1.07; P < 0.001) were independent predictors of upstaging. cT1/pT3a group had worse 2-year (94% vs. 99%) recurrence-free survival (P < 0.001). Conclusions: Upstaging to pT3a in patients with cT1 renal mass undergoing RAPN represents an uncommon event, involving less than 5% of cases. Pathologic upstaging might translate into worse oncological outcomes, and therefore strict follow-up protocols should be applied in these cases.
AB - Objectives: Surgically treated clinical T1 (cT1) kidney cancer has in general a good prognosis, but there is a risk of upstaging that can potentially jeopardize the oncological outcomes after partial nephrectomy (PN). Aim of this study is to analyze the outcomes of robot-assisted PN (RAPN) for cT1 kidney cancer upstaged to pT3a, and to identify predictors of upstaging. Material and methods: The study cohort included 1,640 cT1 patients who underwent RAPN between 2005 and 2018 at 10 academic institutions. Multivariate logistic regression model was used to assess the predictors of upstaging. Kaplan-Meier curves and multivariable Cox regression analyses were used to evaluate recurrence-free survival and overall survival. Results: Overall, 74 (4%) were upstaged cases (cT1/pT3a). Upstaged patients presented larger renal tumors (3.1 vs. 2.4 cm; P = 0.001), and higher R.E.N.A.L. score (8.0 vs. 6.0; P = 0.004). cT1/pT3a group had higher rate of intraoperative complications (5 vs. 1% P = 0.032), higher pathological tumor size (3.2 vs. 2.5 cm; P < 0.001), higher rate of Fuhrman grade ≥3 (32 vs. 17%; P = 0.002), and higher number of sarcomatoid differentiation (4 vs. 1%; P = 0.008). Chronic kidney disease (CKD) stage ≥3 (OR: 2.54; P < 0.014), and clinical tumor size (OR: 1.07; P < 0.001) were independent predictors of upstaging. cT1/pT3a group had worse 2-year (94% vs. 99%) recurrence-free survival (P < 0.001). Conclusions: Upstaging to pT3a in patients with cT1 renal mass undergoing RAPN represents an uncommon event, involving less than 5% of cases. Pathologic upstaging might translate into worse oncological outcomes, and therefore strict follow-up protocols should be applied in these cases.
KW - Outcomes
KW - Predictors
KW - Robotic partial nephrectomy
KW - Upstaging
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U2 - 10.1016/j.urolonc.2019.12.024
DO - 10.1016/j.urolonc.2019.12.024
M3 - Article
C2 - 31956077
AN - SCOPUS:85077980328
VL - 38
SP - 286
EP - 292
JO - Urologic Oncology
JF - Urologic Oncology
SN - 1078-1439
IS - 4
ER -