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Título

REFINING PROGNOSTIC ASSESSMENT OF PT3A RENAL CELL CARCINOMA: RESULTS FROM A RETROSPECTIVE COHORT

Resumo

Purpose: to evaluate the clinical and pathological factors in patients with TNM pT3aN0M0 renal cell carcinoma localized and provide a tool to classify patients for high-risk of recurrence. We retrospectively collected the data of 739 adults patients who underwent radical nephrectomy for renal cell carcinoma and analyzed 362 patients classified as pT3aN0M0 stage between December 2007 and January 2022 in a single tertiary oncological institution. Clinical characteristics, clinical-pathological staging, and histopathological characteristics such as histological grade, lymphovascular invasion, tumor thrombus in the renal vein, involvement of the renal sinus and perirenal fat, sarcomatoid pattern and presence of coagulative tumor necrosis were analyzed. Survival analyses and Prognostic factors were determined using Kaplan-Meier curve and Cox regression analyses. Overall, 362 patients pT3a 65% (n=235) were male. Recurrence occurred in 22.65% (n=77) of patients, death in 17.67% (n=64), and cancer-specific death in 12.15% (n=44). The median follow-up was 40.21 months. In univariate analysis, the presence of a sarcomatoid pattern was the most significant factor associated with tumoral recurrence (hazard ratio [HR]:4.635, 95% CI:1.98–10.82, p < 0.001) and overall survival (HR:5.563, 95% CI:2.36 - 12.10). The presence of coagulative tumor necrosis was associated with cancer-specific survival (HR:7.889, 95% CI:3.04 - 20.42). Multivariable analysis showed associations between tumoral recurrence and neutrophil-lymphocyte ratio, renal sinus fat invasion, weight loss, and Fuhrman grade. The variables associated with cancer-specific survival and overall survival were the presence of a sarcomatoid pattern or coagulative tumor necrosis. The pT3a renal cell carcinoma group exhibited different characteristics, and those with unfavorable characteristics for tumoral recurrence deserve greater attention during follow-up. These findings may be the targets of future studies on adjuvant therapy.