Abstract：
To examine the prognostic significance of perinephric fat, renal sinus fat, and renal vein invasion in patients with pT3a renal cell carcinoma (RCC) by histologic type.
A population-based retrospective cohort study of patients with pT3aN0M0 RCC was performed using Surveillance, Epidemiology, and End Results (SEER) data for the years 2010 through 2019. Cox proportional hazards models were used to examine the relationship between pT3a subclassification groups and cancer-specific survival (CSS) by histological subtype (clear cell, papillary, chromophobe, and other).
The cohort consisted of 10,170 patients with pT3a RCC, including 8,446 (83.0%) with clear cell RCC and 1,724 (17.0%) with nonclear cell RCC (nccRCC). Median follow up was 36 months. Differences in CSS by pT3a subclassification groups were observed in all histological subtypes but were most pronounced in nccRCC, specifically papillary RCC. Compared to perinephric fat (PF) invasion only, renal vein (RV) invasion (HR = 4.9, 95%CI: 2.5-9.3, P < 0.01), renal sinus fat invasion (HR = 3.0, 95%CI: 1.4-6.2), RV and PF invasion (HR = 7.5, 95%CI: 3.5-16.0), and combination of all three characteristics (HR = 4.4, 95%CI: 1.2-15.5) were associated with worse CSS in patients with papillary RCC.
We examined the prognostic role of pT3a staging subclassifications in RCC by histologic subtype and observed survival differences, particularly in papillary RCC. Our findings highlight the need to refine pT3a staging criteria to help guide individualized, multimodal treatment strategies for locally advanced RCC.
A population-based retrospective cohort study of patients with pT3aN0M0 RCC was performed using Surveillance, Epidemiology, and End Results (SEER) data for the years 2010 through 2019. Cox proportional hazards models were used to examine the relationship between pT3a subclassification groups and cancer-specific survival (CSS) by histological subtype (clear cell, papillary, chromophobe, and other).
The cohort consisted of 10,170 patients with pT3a RCC, including 8,446 (83.0%) with clear cell RCC and 1,724 (17.0%) with nonclear cell RCC (nccRCC). Median follow up was 36 months. Differences in CSS by pT3a subclassification groups were observed in all histological subtypes but were most pronounced in nccRCC, specifically papillary RCC. Compared to perinephric fat (PF) invasion only, renal vein (RV) invasion (HR = 4.9, 95%CI: 2.5-9.3, P < 0.01), renal sinus fat invasion (HR = 3.0, 95%CI: 1.4-6.2), RV and PF invasion (HR = 7.5, 95%CI: 3.5-16.0), and combination of all three characteristics (HR = 4.4, 95%CI: 1.2-15.5) were associated with worse CSS in patients with papillary RCC.
We examined the prognostic role of pT3a staging subclassifications in RCC by histologic subtype and observed survival differences, particularly in papillary RCC. Our findings highlight the need to refine pT3a staging criteria to help guide individualized, multimodal treatment strategies for locally advanced RCC.
摘要：
目的：为了检查肾周脂肪的预后意义，肾窦脂肪,pT3a肾细胞癌（RCC）患者的组织学类型和肾静脉浸润。
方法：使用监测对pT3aN0M0RCC患者进行了一项基于人群的回顾性队列研究，流行病学,和2010年至2019年的最终结果(SEER)数据。Cox比例风险模型用于通过组织学亚型（透明细胞，乳头状，发色,和其他）。
结果：该队列包括10,170名pT3aRCC患者，包括8,446（83.0％）的透明细胞RCC和1,724（17.0％）的非透明细胞RCC（nccRCC）。中位随访时间为36个月。在所有组织学亚型中观察到pT3a亚分类组的CSS差异，但在nccRCC中最为明显，特别是乳头状RCC。仅与肾周脂肪（PF）侵袭相比，肾静脉（RV）侵犯（HR=4.9，95CI：2.5-9.3，P<0.01），肾窦脂肪侵犯（HR=3.0，95CI：1.4-6.2），RV和PF侵袭（HR=7.5，95CI：3.5-16.0），所有三个特征的组合（HR=4.4，95CI：1.2-15.5）与乳头状RCC患者的CSS较差相关。
结论：我们通过组织学亚型检查了肾癌pT3a分期亚分类的预后作用，并观察了生存差异，特别是乳头状RCC。我们的发现强调需要完善pT3a分期标准，以帮助指导个性化，局部晚期碾压混凝土的多模态处理策略。
方法：使用监测对pT3aN0M0RCC患者进行了一项基于人群的回顾性队列研究，流行病学,和2010年至2019年的最终结果(SEER)数据。Cox比例风险模型用于通过组织学亚型（透明细胞，乳头状，发色,和其他）。
结果：该队列包括10,170名pT3aRCC患者，包括8,446（83.0％）的透明细胞RCC和1,724（17.0％）的非透明细胞RCC（nccRCC）。中位随访时间为36个月。在所有组织学亚型中观察到pT3a亚分类组的CSS差异，但在nccRCC中最为明显，特别是乳头状RCC。仅与肾周脂肪（PF）侵袭相比，肾静脉（RV）侵犯（HR=4.9，95CI：2.5-9.3，P<0.01），肾窦脂肪侵犯（HR=3.0，95CI：1.4-6.2），RV和PF侵袭（HR=7.5，95CI：3.5-16.0），所有三个特征的组合（HR=4.4，95CI：1.2-15.5）与乳头状RCC患者的CSS较差相关。
结论：我们通过组织学亚型检查了肾癌pT3a分期亚分类的预后作用，并观察了生存差异，特别是乳头状RCC。我们的发现强调需要完善pT3a分期标准，以帮助指导个性化，局部晚期碾压混凝土的多模态处理策略。
