Introduction:

We compared survival outcomes and predictors in patients with upstaged T3a Renal Cell Carcinoma (RCC) versus non-upstaged pT3a RCC, as comparison of pathologically-upstaged T3a RCC and T3a RCC which was not upstaged has not been performed.

Methods:

We conducted a multicenter retrospective analysis. Patients were classified as cT1/cT2 RCC upstaged (pT3a-US) or non-upstaged (cT3a/pT3a-NUS). Primary outcome was All-Cause Mortality (ACM). Secondary outcomes were Cancer-Specific Mortality (CSM), and Recurrence. Multivariable Cox regression analysis (MVA) were conducted for outcomes. Kaplan-Meier Analyses (KMA) were conducted to compare Overall (OS), Cancer-Specific (CSS), and Recurrence-Free Survival (RFS), in pT3a-US and pT3a-NUS.

Results:

We analyzed 879 patients [pT3a-US 69; pT3a-NUS 188; median follow-up 48 months]. MVA for ACM demonstrated increasing tumor size (HR 1.07, p=0.022), high-grade (HR2.74, p<0.001) as independent risk factors. MVA for CSM demonstrated increasing tumor size (HR 1.11, p=0.005), high-grade (HR 2.36, p=0.003), and positive margin (HR 5.58, p=0.007) as independent predictors. MVA for recurrence revealed increasing tumor size (HR 1.05, p=0.05), high-grade (HR 3.55, p<0.001), and positive margin (HR 3.44, p<0.001) as independent predictors. pT3a-US was not an independent predictor in ACM (p=0.204), CSM (p=0.711), or recurrence (p=0.934). Comparing pT3a-NUS vs. pT3a-US, KMA revealed no difference in 5-year OS (60% vs. 62%, p=0.378), and worsened 5-year CSS and RFS were worse for pT3a-NUS (51% vs. 61%, p=0.04; 42% vs. 63%, p<0.001; Figure).

Conclusion:

Pathological upstaging is not an independent predictor of survival outcomes. In T3a RCC increasing tumor size and high-grade or presence of positive margin are main drivers of survival outcomes. 

Funding: N/A