Prognostic factors for tumour recurrence in patients with localised T3a renal cancer following radical nephrectomy
BAUS ePoster online library. Low Z. 06/23/21; 319034; p12-6
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Zhi Low
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Abstract
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Introduction and Objectives
The advancement in systemic therapies for renal cancer is remarkable, but selecting patients with high recurrence risk who might benefit from adjuvant treatment is challenging. We investigate prognostic factors for disease recurrence in patients with pT3aN0M0 renal cancer following radical nephrectomy.
Patients and Methods
A retrospective review of 240 T3aN0M0 radical nephrectomy patients between 1995 and 2020 at a single tertiary hospital was conducted. Data was extracted from a prospectively collated renal cancer database: Histopathologic subtypes, tumour diameter and number, margin status, patterns of extrarenal extension, and haematological and biochemical blood parameters were evaluated on univariable and multivariable analysis using Cox proportional hazards regression.
Results
Recurrence rates at 1 and 5 years were 24.6% and 37.8% respectively: the most common sites being lung, liver and regional nodes respectively. Only ISUP grade, presence of necrosis and positive margins were identified as significant independent predictors of disease recurrence on multivariate analysis. Individually, T3a manifestations (perinephric fat, sinus fat, segmental vein, renal vein invasion) conferred no significant increase in recurrence risk: this increased with statistical significance when more than one factor was present, rising most when all four were present (HR 3.0, 95%CI 1.46-6.16, p<0.005)
Conclusion
Pathological T3a renal cancer represents a heterogenous group, the majority of whom will not have disease recurrence, will not benefit from, and can avoid the toxicity of adjuvant treatment. This study identifies high risk patients who may be more likely to benefit from adjuvant treatment and should be considered for trials.
The advancement in systemic therapies for renal cancer is remarkable, but selecting patients with high recurrence risk who might benefit from adjuvant treatment is challenging. We investigate prognostic factors for disease recurrence in patients with pT3aN0M0 renal cancer following radical nephrectomy.
Patients and Methods
A retrospective review of 240 T3aN0M0 radical nephrectomy patients between 1995 and 2020 at a single tertiary hospital was conducted. Data was extracted from a prospectively collated renal cancer database: Histopathologic subtypes, tumour diameter and number, margin status, patterns of extrarenal extension, and haematological and biochemical blood parameters were evaluated on univariable and multivariable analysis using Cox proportional hazards regression.
Results
Recurrence rates at 1 and 5 years were 24.6% and 37.8% respectively: the most common sites being lung, liver and regional nodes respectively. Only ISUP grade, presence of necrosis and positive margins were identified as significant independent predictors of disease recurrence on multivariate analysis. Individually, T3a manifestations (perinephric fat, sinus fat, segmental vein, renal vein invasion) conferred no significant increase in recurrence risk: this increased with statistical significance when more than one factor was present, rising most when all four were present (HR 3.0, 95%CI 1.46-6.16, p<0.005)
Conclusion
Pathological T3a renal cancer represents a heterogenous group, the majority of whom will not have disease recurrence, will not benefit from, and can avoid the toxicity of adjuvant treatment. This study identifies high risk patients who may be more likely to benefit from adjuvant treatment and should be considered for trials.
Introduction and Objectives
The advancement in systemic therapies for renal cancer is remarkable, but selecting patients with high recurrence risk who might benefit from adjuvant treatment is challenging. We investigate prognostic factors for disease recurrence in patients with pT3aN0M0 renal cancer following radical nephrectomy.
Patients and Methods
A retrospective review of 240 T3aN0M0 radical nephrectomy patients between 1995 and 2020 at a single tertiary hospital was conducted. Data was extracted from a prospectively collated renal cancer database: Histopathologic subtypes, tumour diameter and number, margin status, patterns of extrarenal extension, and haematological and biochemical blood parameters were evaluated on univariable and multivariable analysis using Cox proportional hazards regression.
Results
Recurrence rates at 1 and 5 years were 24.6% and 37.8% respectively: the most common sites being lung, liver and regional nodes respectively. Only ISUP grade, presence of necrosis and positive margins were identified as significant independent predictors of disease recurrence on multivariate analysis. Individually, T3a manifestations (perinephric fat, sinus fat, segmental vein, renal vein invasion) conferred no significant increase in recurrence risk: this increased with statistical significance when more than one factor was present, rising most when all four were present (HR 3.0, 95%CI 1.46-6.16, p<0.005)
Conclusion
Pathological T3a renal cancer represents a heterogenous group, the majority of whom will not have disease recurrence, will not benefit from, and can avoid the toxicity of adjuvant treatment. This study identifies high risk patients who may be more likely to benefit from adjuvant treatment and should be considered for trials.
The advancement in systemic therapies for renal cancer is remarkable, but selecting patients with high recurrence risk who might benefit from adjuvant treatment is challenging. We investigate prognostic factors for disease recurrence in patients with pT3aN0M0 renal cancer following radical nephrectomy.
Patients and Methods
A retrospective review of 240 T3aN0M0 radical nephrectomy patients between 1995 and 2020 at a single tertiary hospital was conducted. Data was extracted from a prospectively collated renal cancer database: Histopathologic subtypes, tumour diameter and number, margin status, patterns of extrarenal extension, and haematological and biochemical blood parameters were evaluated on univariable and multivariable analysis using Cox proportional hazards regression.
Results
Recurrence rates at 1 and 5 years were 24.6% and 37.8% respectively: the most common sites being lung, liver and regional nodes respectively. Only ISUP grade, presence of necrosis and positive margins were identified as significant independent predictors of disease recurrence on multivariate analysis. Individually, T3a manifestations (perinephric fat, sinus fat, segmental vein, renal vein invasion) conferred no significant increase in recurrence risk: this increased with statistical significance when more than one factor was present, rising most when all four were present (HR 3.0, 95%CI 1.46-6.16, p<0.005)
Conclusion
Pathological T3a renal cancer represents a heterogenous group, the majority of whom will not have disease recurrence, will not benefit from, and can avoid the toxicity of adjuvant treatment. This study identifies high risk patients who may be more likely to benefit from adjuvant treatment and should be considered for trials.
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