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548 DIFFERENT SURVIVAL IN PT3A RENAL CELL CARCINOMA WITH RENAL SINUS FAT INVASION OR PERINEPHRIC FAT INVASION
P31 RENAL CANCER: PROGNOSIS Thursday, 22 March, 14.00-15.30, Room 15B
545
A new staging system for locally advanced renal cell carcinoma: a multicentric European study including 2,000 patients
Ficarra V.1, Guillè F.2, Galfano A.3, Tostain J.4, Novara G.3, Lang H.5, Mulders P.F.A.6, Cindolo L.7, Mejean A.8, Chautard D.9, Descotes J.L.10, De La Taille A.11, Schips L.12, Salomon L.11, Zattoni F.1, Artibani W.3, Patard J.J.2 University of Verona, Department of Urology, Verona, Italy, 2University of Rennes, Department of Urology, Rennes, France, 3University of Padua, Department of Urology, Padua, Italy, 4University of Saint Etienne, Department of Urology, Saint Etienne, France, 5University of Strasbourg, Department of Urology, Strasbourg, France, 6University of Nijmegen, Department of Urology, Nijmegen, The Netherlands, 7University of Naples, Department of Urology, Naples, Italy, 8Necker Hospital, Department of Urology, Paris, France, 9University of Angers, Department of Urology, Angers, France, 10University of Grenoble, Department of Urology, Grenoble, France, 11University of Creteil, Department of Urology, Creteil, France, 12University of Graz, Department of Urology, Graz, Austria 1
Introduction & Objectives: The aim of our study is to provide an adequate prognostic stratification for locally advanced renal cell carcinoma (RCC) and to propose a new classification system. Material & Methods: We analyzed the clinical and pathological data of 1,969 patients undergoing radical nephrectomy for pT3-4 RCC at 12 European centers (Angers, Creteil, Graz, Grenoble, Naples, Necker, Nijemegen, Padova, Rennes, Saint Etienne, Strasbourg, Verona). Cancer-specific survivals were estimated using the Kaplan-Meier method. The log rank test was used to compare survival curves and for univariate analysis. Cox’s proportional hazards regression model was used for multivariate analysis. Results: Median follow-up of alive patients was 49 months (i.r. 23-84). According to median survival values, we identified 3 different prognostic groups: 1) patients with renal vein thrombosis (117 months) or fat invasion (98 months) or vena cava thrombosis below the diaphragm (67 months); 2) patients with adrenal invasion only (24 months) or renal vein thrombosis plus fat invasion (24 months) or vena cava below the diaphragm plus fat invasion (24 months); 3) patients with renal or caval thrombosis below the diaphragm (11 months) or vena cava thrombosis above the diaphragm (12 months)or Gerota’s fascia invasion (12 months). Five-year cancer-specific survival rates were 61% in the first group; 35% in the second groupand 12.9% in the third (p<0.0001). After the exclusion of patients with nodal involvement or distant metastases, the proposed classification maintained a statistical significance (p<0.0001). The presence of local or systemic symptoms (HR 1.403; 95%CI 1.162-1.693, p<0.0001), pathological tumor size > 8 cm (HR 1.319; 95%CI 1.135-1.532, p<0.0001), regional lymph nodes involvement (HR 1.827; 95%CI 1.605-2.078, p<0.0001), distant metastases (HR 2.717; 95%CI 2.329-3.168, p<0.0001), Fuhrman nuclear grading (HR 1.209; 95%CI 1.1471.274, p<0.0001), and the new classification (HR 1.628; 95%CI 1.475-1.797, p<0.0001) were the variables able to independently predict cancer-specific survival at multivariate analysis.
546
Prognosis value of renal vein (RV) and inferior vena cava (IVC) involvement in renal cell carcinoma (RCC)
Wagner B.1, Patard J.J.2, Méjean A.3, Zigeuner R.4, Bensalah K.2, Schips L.4, Ficarra V.5, Tostain J.6, Mulders P.F.A.7, Chautard D.8, Descotes J.L.9, De La Taille A.10, Salomon L.10, Cindolo L.11, Prayer-Galetti T.12, Valéri A.13, Meyer N.14, Jacqmin D.1, Lang H.1 Hôpitaux universitaires, Urology, Strasbourg, France, 2University Medical Center, Urology, Rennes, France, 3Hôpital Necker, Urology, Paris, France, 4University Medical Center, Urology, Graz, Austria, 5University Medical Center, Urology, Verona, Italy, 6University Medical Center, Urology, Saint-Etienne, France, 7University Medical Center, Urology, Nijmegen, The Netherlands, 8University Medical Center, Urology, Angers, France, 9University Medical Center, Urology, Grenoble, France, 10Hôpital Mondor, Urology, Créteil, France, 11University Medical Center, Urology, Benevento, Italy, 12University Medical Center, Urology, Padua, Italy, 13University Medical Center, Urology, Brest, France, 14Hôpitaux universitaires, Statistic, Strasbourg, France 1
Introduction & Objectives: To evaluate prognostic value of IVC involvement in a large series of pT3b and pT3c RCC. Material & Methods: Data was extracted from two national and international RCC databases including 1192 patients with pT3b and pT3c RCC who had been treated by radical nephrectomy between 1982 and 2003. Age, gender, clinical symptoms, performance status ECOG, TNMstage, tumor size, adrenal invasion, perinephric fat invasion, histological type and Fuhrman grade were available. Uni- and multivariate analysis were performed by using the Kaplan Meier and Cox methods respectively. Results: Median follow-up was 61,4 months (confidence interval: 56,3-66,5 months). They were 783 males and 409 females. Mean age was 63,2 years and mean tumor size was 8,9 cm. 933 (78,3%) patients had tumors with invasion limited to the renal vein (Gr 1), 196 (16,4%) tumors invaded the IVC below the diaphragm (Gr 2) and 63 tumors (5,3%) had an extensive IVC invasion above the diaphragm (Gr 3). In univariate analysis Gr 1 had a significantly better survival outcome than patients of Gr 2 and 3. Median survival were 52 months for Gr 1 and 25,8 and 18 months for Gr 2 and Gr 3 respectively (p<0,001) (p<=0,001). There were no significant difference between Gr 2 and Gr 3 (p=0,613). Other factors who influenced survival in univariate analysis: Clinical symptoms (p<0,001), tumor size (p<0,001), perinephric fat invasion (p<0,001), Fuhrman grade (p<0,001), histological type (p=0,021), lymph node invasion (p<0,001) and distant metastasis (p<0,001). Independent prognostic factors in multivariate analysis were: tumor size (p=0,013), perinephric fat invasion (p=0,003), lymph node invasion (p<0,001), distant metastasis (p<0,001) and IVC invasion (p=0,008).
Conclusions: The results of this multicentric study suggest the necessity to reclassify locally advanced RCC according to the 3 described prognostic categories.
Conclusions: IVC invasion of any level decreased significantly and independently prognosis of patients with RCC. The limit between pT3b and pT3c RCC need to be re-evaluated in a venous invasion above and below the junction of the RV into the IVC.
547
548
Ipsilateral adrenal gland invasion is an unfavourable feature for locally advanced renal cell carcinoma
Different survival in pT3a renal cell carcinoma with renal sinus fat invasion or perinephric fat invasion
Novara G.1, Schips L.2, Galfano A.1, Guillè F.3, Tostain J.4, Lang H.5, Mulders P.F.A.6, Cindolo L.7, Chautard D.8, Descotes J.L.9, De La Taille A.10, Salomon L.10, Zigeuner R.2, Mejean A.11, Zattoni F.12, Artibani W.1, Patard J.J.3, Ficarra V.12
Roscigno M.1, Bertini R.1, Cozzarini C.2, Pasta A.1, Sangalli M.1, Strada E.1, Petralia G.1, Mazzoccoli B.1, Di Girolamo V.1, Colombo R.1, Rigatti P.1
University of Padua, Department of Urology, Padua, Italy, 2University of Graz, Department of Urology, Graz, Austria, 3University of Rennes, Department of Urology, Rennes, France, 4 University of Saint Etienne, Department of Urology, Saint Etienne, France, 5University of Strasbourg, Department of Urology, Strasbourg, France, 6University of Nijmegen, Department of Urology, Nijmegen, The Netherlands, 7University of Naples, Department of Urology, Naples, Italy, 8University of Angers, Department of Urology, Angers, France, 9University of Grenoble, Department of Urology, Grenoble, France, 10University of Creteil, Department of Urology, Creteil, France, 11Hospital Necker, Department of Urology, Paris, France, 12University of Verona, Department of Urology, Verona, Italy
1
1
Introduction & Objectives: The aim of our study is to verify the impact on prognosis of ipsilateral adrenal gland invasion from renal cell carcinoma (RCC). Material & Methods: We analyzed the clinical and pathological data of 1,969 patients undergoing radical nephrectomy for pT3-4 RCC at 12 European centers (Angers, Creteil, Graz, Grenoble, Naples, Necker, Nijmegen, Padova, Rennes, Saint Etienne, Strasbourg, Verona). Cancerspecific survivals were estimated using the Kaplan-Meier method. The log rank test was used to compare curves and for univariate analysis. Results: The analysis included 1,969 patients. Median age was 64 (i.r. 55-71). At a median follow-up of 28 months (i.r. 11-64), 959 patients (48.7%) were alive and disease-free, 920 (46.7%) had died of the disease and 90 (4.6%) of other causes. Median follow-up of the 959 living patients was 49 months (i.r. 23-84). Direct ipsilateral adrenal gland invasion was found in 108 patients (5.5%). An exclusive adrenal gland involvement was recorded only in 46 pT3a cases (42.5%). In pT3b patients, the adrenal gland invasion was associated with a concomitant renal vein or subdiaphragmatic caval tumour thrombosis in 45 cases (41.5%). Moreover, the adrenal gland involvement was observed in 5 (4.5%) pT3c and in 12 (11.5%) pT4 tumours. Patients with ipsilateral adrenal invasion alone showed a worse cancer-specific survival than patients with perinephric fat invasion alone (p=0.0002). Patients with ipsilateral adrenal gland involvement and neoplastic thrombosis of renal vein or infradiaphragmatic vena cava showed significantly worse cancer-specific survival than patients with adrenal gland involvement alone (p=0.002) or than the 660 pT3b patients without adrenal gland involvement (p<0.0001). No cancer-specific survival difference has been found between patients with and without direct adrenal gland invasion, considering both pT3c (p=0.06) and pT4 patients (p=0.38). Conclusions: The presence of adrenal gland invasion is associated with a significant impairment of prognosis both into pT3a and pT3b categories. This local extension of the primary tumour does not impact negatively on the prognosis of pT3c and pT4 RCC.
Vita Salute University San Raffaele, Urology, Milan, Italy, 2Vita Salute University San Raffaele, Oncology, Milan, Italy Introduction & Objectives: To evaluate the different impact of renal sinus fat and perinephric fat invasion on cancer-specific survival, in pts affected by pT3a renal cell carcinoma (RCC). Material & Methods: From 1987 to 2004, 103 patients underwent radical nephrectomy for pT3a RCC (TNM 2002). Eighty-nine pts had perinephric or renal sinus fat invasion; 14 pT3a pts with direct adrenal invasion were excluded, due to the more aggressive behaviour of this subgroup of pT3a RCC. Patient characteristics: median age 61 yrs (range 29-83), M/F 63/26, perinephric fat/ renal sinus fat invasion 59/30, G1-2/G3-4 50/39, pN0/pN1-2/pNx 48/17/24, pM0/ pM+ 62/27. Associations with outcome were evaluated by univariate analysis (Kaplan-Meier model) and multivariate Cox proportional hazard model, including age, Fuhrman grade (G1-2 vs. G3-4), metastatic and nodal status, pathological tumor dimension and presence/absence of renal sinus fat invasion. Results: Median follow-up was 42,9 months. The actuarial 5-year CSS was significantly lower in case of sinus fat invasion than in case of perinephric fat invasion (49% vs. 74%; p=0.006). Patients with sinus fat invasion were 53% more like to die of RCC than those with perinephric fat invasion (RR: 1,53; 95% CI 1,07-2,08; p=0.006). Multivariate analysis highlighted the independent prognostic role of the presence of synchronous metastases (p=0,014; HR 3,2) but also of renal sinus fat invasion (p=0,048; HR 2,7), while the other above-mentioned variables are not significantly associated to cancer-specific survival. Conclusions: This study confirms that, in pT3a RCC, renal sinus fat invasion significantly affects the oncological outcome with respect to perinephric fat invasion.
Eur Urol Suppl 2007;6(2):159
545
A new staging system for locally advanced renal cell carcinoma: a multicentric European study including 2,000 patients
Ficarra V.1, Guillè F.2, Galfano A.3, Tostain J.4, Novara G.3, Lang H.5, Mulders P.F.A.6, Cindolo L.7, Mejean A.8, Chautard D.9, Descotes J.L.10, De La Taille A.11, Schips L.12, Salomon L.11, Zattoni F.1, Artibani W.3, Patard J.J.2 University of Verona, Department of Urology, Verona, Italy, 2University of Rennes, Department of Urology, Rennes, France, 3University of Padua, Department of Urology, Padua, Italy, 4University of Saint Etienne, Department of Urology, Saint Etienne, France, 5University of Strasbourg, Department of Urology, Strasbourg, France, 6University of Nijmegen, Department of Urology, Nijmegen, The Netherlands, 7University of Naples, Department of Urology, Naples, Italy, 8Necker Hospital, Department of Urology, Paris, France, 9University of Angers, Department of Urology, Angers, France, 10University of Grenoble, Department of Urology, Grenoble, France, 11University of Creteil, Department of Urology, Creteil, France, 12University of Graz, Department of Urology, Graz, Austria 1
Introduction & Objectives: The aim of our study is to provide an adequate prognostic stratification for locally advanced renal cell carcinoma (RCC) and to propose a new classification system. Material & Methods: We analyzed the clinical and pathological data of 1,969 patients undergoing radical nephrectomy for pT3-4 RCC at 12 European centers (Angers, Creteil, Graz, Grenoble, Naples, Necker, Nijemegen, Padova, Rennes, Saint Etienne, Strasbourg, Verona). Cancer-specific survivals were estimated using the Kaplan-Meier method. The log rank test was used to compare survival curves and for univariate analysis. Cox’s proportional hazards regression model was used for multivariate analysis. Results: Median follow-up of alive patients was 49 months (i.r. 23-84). According to median survival values, we identified 3 different prognostic groups: 1) patients with renal vein thrombosis (117 months) or fat invasion (98 months) or vena cava thrombosis below the diaphragm (67 months); 2) patients with adrenal invasion only (24 months) or renal vein thrombosis plus fat invasion (24 months) or vena cava below the diaphragm plus fat invasion (24 months); 3) patients with renal or caval thrombosis below the diaphragm (11 months) or vena cava thrombosis above the diaphragm (12 months)or Gerota’s fascia invasion (12 months). Five-year cancer-specific survival rates were 61% in the first group; 35% in the second groupand 12.9% in the third (p<0.0001). After the exclusion of patients with nodal involvement or distant metastases, the proposed classification maintained a statistical significance (p<0.0001). The presence of local or systemic symptoms (HR 1.403; 95%CI 1.162-1.693, p<0.0001), pathological tumor size > 8 cm (HR 1.319; 95%CI 1.135-1.532, p<0.0001), regional lymph nodes involvement (HR 1.827; 95%CI 1.605-2.078, p<0.0001), distant metastases (HR 2.717; 95%CI 2.329-3.168, p<0.0001), Fuhrman nuclear grading (HR 1.209; 95%CI 1.1471.274, p<0.0001), and the new classification (HR 1.628; 95%CI 1.475-1.797, p<0.0001) were the variables able to independently predict cancer-specific survival at multivariate analysis.
546
Prognosis value of renal vein (RV) and inferior vena cava (IVC) involvement in renal cell carcinoma (RCC)
Wagner B.1, Patard J.J.2, Méjean A.3, Zigeuner R.4, Bensalah K.2, Schips L.4, Ficarra V.5, Tostain J.6, Mulders P.F.A.7, Chautard D.8, Descotes J.L.9, De La Taille A.10, Salomon L.10, Cindolo L.11, Prayer-Galetti T.12, Valéri A.13, Meyer N.14, Jacqmin D.1, Lang H.1 Hôpitaux universitaires, Urology, Strasbourg, France, 2University Medical Center, Urology, Rennes, France, 3Hôpital Necker, Urology, Paris, France, 4University Medical Center, Urology, Graz, Austria, 5University Medical Center, Urology, Verona, Italy, 6University Medical Center, Urology, Saint-Etienne, France, 7University Medical Center, Urology, Nijmegen, The Netherlands, 8University Medical Center, Urology, Angers, France, 9University Medical Center, Urology, Grenoble, France, 10Hôpital Mondor, Urology, Créteil, France, 11University Medical Center, Urology, Benevento, Italy, 12University Medical Center, Urology, Padua, Italy, 13University Medical Center, Urology, Brest, France, 14Hôpitaux universitaires, Statistic, Strasbourg, France 1
Introduction & Objectives: To evaluate prognostic value of IVC involvement in a large series of pT3b and pT3c RCC. Material & Methods: Data was extracted from two national and international RCC databases including 1192 patients with pT3b and pT3c RCC who had been treated by radical nephrectomy between 1982 and 2003. Age, gender, clinical symptoms, performance status ECOG, TNMstage, tumor size, adrenal invasion, perinephric fat invasion, histological type and Fuhrman grade were available. Uni- and multivariate analysis were performed by using the Kaplan Meier and Cox methods respectively. Results: Median follow-up was 61,4 months (confidence interval: 56,3-66,5 months). They were 783 males and 409 females. Mean age was 63,2 years and mean tumor size was 8,9 cm. 933 (78,3%) patients had tumors with invasion limited to the renal vein (Gr 1), 196 (16,4%) tumors invaded the IVC below the diaphragm (Gr 2) and 63 tumors (5,3%) had an extensive IVC invasion above the diaphragm (Gr 3). In univariate analysis Gr 1 had a significantly better survival outcome than patients of Gr 2 and 3. Median survival were 52 months for Gr 1 and 25,8 and 18 months for Gr 2 and Gr 3 respectively (p<0,001) (p<=0,001). There were no significant difference between Gr 2 and Gr 3 (p=0,613). Other factors who influenced survival in univariate analysis: Clinical symptoms (p<0,001), tumor size (p<0,001), perinephric fat invasion (p<0,001), Fuhrman grade (p<0,001), histological type (p=0,021), lymph node invasion (p<0,001) and distant metastasis (p<0,001). Independent prognostic factors in multivariate analysis were: tumor size (p=0,013), perinephric fat invasion (p=0,003), lymph node invasion (p<0,001), distant metastasis (p<0,001) and IVC invasion (p=0,008).
Conclusions: The results of this multicentric study suggest the necessity to reclassify locally advanced RCC according to the 3 described prognostic categories.
Conclusions: IVC invasion of any level decreased significantly and independently prognosis of patients with RCC. The limit between pT3b and pT3c RCC need to be re-evaluated in a venous invasion above and below the junction of the RV into the IVC.
547
548
Ipsilateral adrenal gland invasion is an unfavourable feature for locally advanced renal cell carcinoma
Different survival in pT3a renal cell carcinoma with renal sinus fat invasion or perinephric fat invasion
Novara G.1, Schips L.2, Galfano A.1, Guillè F.3, Tostain J.4, Lang H.5, Mulders P.F.A.6, Cindolo L.7, Chautard D.8, Descotes J.L.9, De La Taille A.10, Salomon L.10, Zigeuner R.2, Mejean A.11, Zattoni F.12, Artibani W.1, Patard J.J.3, Ficarra V.12
Roscigno M.1, Bertini R.1, Cozzarini C.2, Pasta A.1, Sangalli M.1, Strada E.1, Petralia G.1, Mazzoccoli B.1, Di Girolamo V.1, Colombo R.1, Rigatti P.1
University of Padua, Department of Urology, Padua, Italy, 2University of Graz, Department of Urology, Graz, Austria, 3University of Rennes, Department of Urology, Rennes, France, 4 University of Saint Etienne, Department of Urology, Saint Etienne, France, 5University of Strasbourg, Department of Urology, Strasbourg, France, 6University of Nijmegen, Department of Urology, Nijmegen, The Netherlands, 7University of Naples, Department of Urology, Naples, Italy, 8University of Angers, Department of Urology, Angers, France, 9University of Grenoble, Department of Urology, Grenoble, France, 10University of Creteil, Department of Urology, Creteil, France, 11Hospital Necker, Department of Urology, Paris, France, 12University of Verona, Department of Urology, Verona, Italy
1
1
Introduction & Objectives: The aim of our study is to verify the impact on prognosis of ipsilateral adrenal gland invasion from renal cell carcinoma (RCC). Material & Methods: We analyzed the clinical and pathological data of 1,969 patients undergoing radical nephrectomy for pT3-4 RCC at 12 European centers (Angers, Creteil, Graz, Grenoble, Naples, Necker, Nijmegen, Padova, Rennes, Saint Etienne, Strasbourg, Verona). Cancerspecific survivals were estimated using the Kaplan-Meier method. The log rank test was used to compare curves and for univariate analysis. Results: The analysis included 1,969 patients. Median age was 64 (i.r. 55-71). At a median follow-up of 28 months (i.r. 11-64), 959 patients (48.7%) were alive and disease-free, 920 (46.7%) had died of the disease and 90 (4.6%) of other causes. Median follow-up of the 959 living patients was 49 months (i.r. 23-84). Direct ipsilateral adrenal gland invasion was found in 108 patients (5.5%). An exclusive adrenal gland involvement was recorded only in 46 pT3a cases (42.5%). In pT3b patients, the adrenal gland invasion was associated with a concomitant renal vein or subdiaphragmatic caval tumour thrombosis in 45 cases (41.5%). Moreover, the adrenal gland involvement was observed in 5 (4.5%) pT3c and in 12 (11.5%) pT4 tumours. Patients with ipsilateral adrenal invasion alone showed a worse cancer-specific survival than patients with perinephric fat invasion alone (p=0.0002). Patients with ipsilateral adrenal gland involvement and neoplastic thrombosis of renal vein or infradiaphragmatic vena cava showed significantly worse cancer-specific survival than patients with adrenal gland involvement alone (p=0.002) or than the 660 pT3b patients without adrenal gland involvement (p<0.0001). No cancer-specific survival difference has been found between patients with and without direct adrenal gland invasion, considering both pT3c (p=0.06) and pT4 patients (p=0.38). Conclusions: The presence of adrenal gland invasion is associated with a significant impairment of prognosis both into pT3a and pT3b categories. This local extension of the primary tumour does not impact negatively on the prognosis of pT3c and pT4 RCC.
Vita Salute University San Raffaele, Urology, Milan, Italy, 2Vita Salute University San Raffaele, Oncology, Milan, Italy Introduction & Objectives: To evaluate the different impact of renal sinus fat and perinephric fat invasion on cancer-specific survival, in pts affected by pT3a renal cell carcinoma (RCC). Material & Methods: From 1987 to 2004, 103 patients underwent radical nephrectomy for pT3a RCC (TNM 2002). Eighty-nine pts had perinephric or renal sinus fat invasion; 14 pT3a pts with direct adrenal invasion were excluded, due to the more aggressive behaviour of this subgroup of pT3a RCC. Patient characteristics: median age 61 yrs (range 29-83), M/F 63/26, perinephric fat/ renal sinus fat invasion 59/30, G1-2/G3-4 50/39, pN0/pN1-2/pNx 48/17/24, pM0/ pM+ 62/27. Associations with outcome were evaluated by univariate analysis (Kaplan-Meier model) and multivariate Cox proportional hazard model, including age, Fuhrman grade (G1-2 vs. G3-4), metastatic and nodal status, pathological tumor dimension and presence/absence of renal sinus fat invasion. Results: Median follow-up was 42,9 months. The actuarial 5-year CSS was significantly lower in case of sinus fat invasion than in case of perinephric fat invasion (49% vs. 74%; p=0.006). Patients with sinus fat invasion were 53% more like to die of RCC than those with perinephric fat invasion (RR: 1,53; 95% CI 1,07-2,08; p=0.006). Multivariate analysis highlighted the independent prognostic role of the presence of synchronous metastases (p=0,014; HR 3,2) but also of renal sinus fat invasion (p=0,048; HR 2,7), while the other above-mentioned variables are not significantly associated to cancer-specific survival. Conclusions: This study confirms that, in pT3a RCC, renal sinus fat invasion significantly affects the oncological outcome with respect to perinephric fat invasion.
Eur Urol Suppl 2007;6(2):159