Prognostic value of the involvement of the urinary collecting system in renal cell carcinoma (RCC)

541 PROGNOSTIC COLLECTING Tcrrone

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VALUE OF THE INVOLVEMENT OF THE URINARY SYSTEM IN RENAL CELL CARCINOMA (RCC)

Guercio S.‘. De Luca S.‘, Castelli E.‘, Scoffone C.‘, Tarabuzzi R.‘, Scarpa R.‘, Fontana D.‘, Rocca Rossetti S.‘, Poggio M.’

‘Urologia Universitaria, Science Cliniche e Biologiche, Orbassano, Italy, ‘Urologia Universitaria II, Discipline Medico-Chirurgiche, Torino, Italy, ‘UniversitB di Torino, Scienze Cliniche e Biologiche, Torino, Italy INTRODUCTION & OBJECTIVES: The prognostic role of the invasion of the urinary collecting system (UCS) by RCC has been little studied. Furthermore, in TNM system, except the 1978 edition, the UCS involvement has not been taken into account as a criterion for staging RCC. Aim of this study was to investigate the incidence and the prognostic value of the UCS involvement by RCC. MATERIAL & METHODS: All the pathological reports of the radical nephrectomies performed in two urological centres from November 1983 to September 1999 and from October 1988 to December 1999 respectively, were reviewed in order to evaluate the invasion of the UCS (calices, renal pelvis, ureter). The stage was determined according to the pTNM sixth edition. The tumours with UCS invasion were divided in two groups: group 1 (pTl-pT2, any N, any M) and group 2 (pT3-pT4, any N, any M). The cases without involvement of the UCS represented the control groups. The nonparametric Mann-Whitney U test was used to compare the tumour diameter in the two groups with UCS invasion. Kaplan-Meyer method and log-rank test were used to calculate the cause specific survival rate and to compare the survival curves, respectively. RESULTS: The evaluable patients were 674, while in 61 cases (8.2%) It was not possible to determine if the UCS was involved. The invasion of the UCS was found in 58 cases (8.6%). In the tumours 5 4 cm the UCS invasion was found in 1.7% of the cases. Median follow up was 35.0 months (o-195). Group I had the following characteristics: 21 patients, median age 60.0 years, median tumour diameter 6.0 cm, 2 pTla, 13 pTlb, 6 pT2,3 pNOMI, 1 pNIMI, I pNxM1, 2 Gl, I2 G2, 6 G3, I Gx. The characteristics of group 2 were the following: 37 patients, median age 60 years, median tumour diameter 8.5 cm, I3 pT3a, I8 pT3b, 6 pT4, 8 pNOMl, 7 pNlMl, 7 pNlM0, 1 Gl, 10 G2, 20 G3, 2 G4, 4 Gx. The tumour diameter was significantly higher in group 2 (p
542 PROGNOSTIC TUMOURS

FACTORS

AFFECTING

Rodrieuez A., Bensalah K., Vincendeau Guille F., Lobe1 B., Patard J. Pontchaillou

University

SURVIVAL

IN STAGE

S., Rioux-Leclercq

T 3

N., Manunta

A.,

Hospital, Urology, Rennes, France

INTRODUCTION & OBJECTIVES: To analyse the clinical and pathological factors that may affect survival of patients surgically treated for a stage T3 renal tumour. MATERIAL & METHODS: Between 1984 and 1999 we retrospectively studied the data of I71 patients surgically treated due to a renal tumour classified as T3 (TNM 1997) in our department. The following prognostic factors were analysed: age, sex, tumour size, stage, grade, renal vein invasion with and without thrombus of the cava, perirenal fat invasion, lymphatic metastasis, distant metastasis, and mode of detection (incidental or not). Survival curves were compared with Kaplan-Meier method (log rank test) and a multivariate analysis was performed according to Cox’s model. RESULTS: 46, 118, and 7 patients were stage T3a (26.90/o), T3b (69%). and T3c, respectively. 36 and 37 patients were N+(2l.l%) and M+(21.6%), respectively. I8 (10.5%) had adrenal extension, 90 (52.6%) perirenal fat invasion and 112 (65.5%) renal vein extension, of which 44 (39%) had cava thrombus. The 5 - year survival was 36%. The median survival rates for patients classified as T3a, T3b, and T3c were 56, 43, and I3 months, respectively (p: NS). Univariate analysis demonstrated that symptoms, grade, lymphatic metastasis or distant metastasis (p
CONCLUSIONS: The Invasion of the UCS by RCC is unusual, particularly in small tumours and it does not add any significant information m the current TNM staging system.

CONCLUSIONS: Our study confirms the value of the classic prognostic criteria as: vein invasion, perirenal fat invasion, and distant metastasis. However, mode of detection (incidental or not) and the prcscnce of cava thrombus also appeared to be independent prognostic factors.

543

544

PROGNOSTIC FACTORS CARCINOMA (RCC)

IN THE T3 CATEGORY

OF RENAL CELL

I’crrone C.‘. Gucrc~o S.‘, De Luca S.‘. Castclh E.‘, Poggio M.‘. Scoffonc C‘. TarabuLri R.‘. Porpigha F.‘. Scarpa R.‘. Fontana D.‘, Rocca Ross&i S.’ ‘Urologia Universitaria, Scienze Cliniche e Biologiche, Orbassano, Italy, ‘Urologia Universitaria II, Discipline Medico-Chirurgiche, Torino, Italy, ‘UniversitB degli Studi, Discipline Medico-Chirurgiche, Torino, Italy INTRODUCTION & OBJECTIVES: The actual stratification of T3 category of RCC can be questionable. Furthermore, the classification of the tumour involving renal sinus fat has remained unspecified until the new edition of the TNM system. The aim of this study was to investigate the prognostic value of the invasion of the renal vein/vena cava, perinephric fat and renal sinus fat, in itself. MATERIAL & METHODS: All the radical nephrectomies performed in two urological centres from November 1983 to September 1999 and from October 198X to December 1999 respectively, were reviewed. We analysed all the pathological reports and we established 4 groups as pT3 category: I) tumour invading the tissue surrounding the kidney and/or adrenal gland but not beyond the Gerota’s fascia 2) tumour invading renal sinus fat 3) tumour grossly extending into the renal vein/venn cava 4) tumour extending into both the tissue surrounding the kidney and into the renal vein/vena cava. The tumour diameters were also recorded. Kaplan-Meyer method and log-rank test were used to calculate the cause specific survival rate and to compare the survival curves, respectively. The prognostic independent role of the above mentioned parameters (groups I ,2,3,4 and tumour diameter) were assessed by Cox proportional hazards analysis. a

IMPACT OF CANCER ASSOCIATED SYMPTOMS AND BODY MASS INDEX ON PROGNOSIS OF PATIENTS WITH RENAL CELL CARCINOMA S&pa

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INTRODUCTION & OBJECTIVES: An increasq numhcr of renal ccl1 cucinomas (RCC) I* detected mudentally hy rootme ultravund today In addition. an increawd madence of renal cell carcinoma (RCC) I” obese pattents has been reported by wveral author?. The a,nl of our study wit> to evaluate hoth the impact of body mass index (BMI) and of cancer associated symptoms present at diagnosis of RCC‘ on the prognovs of patients t’xlIENTS & METHODS: brom 01/1494 to 12/2lJOO, 6Y4 operations for RCC in 6X4 pat~entr (418 males, 267 females) have been performed at our mwutmn mcludmg 634 radical and 60 partial ncphrectomics BMI and prcscncc of ~ymptomr at diagnow were evaluated. Overall, tumour-specificand progression free su~~val was determmed using the Kaplan-Maer method. the prognosis of patients m association with symptoms and BMI was compared using the Log-Rank test. For multivariate analysis of cancer specific SUTVIVBI, the Cox regression model was used

including pFstagc, grade, nmmur diameter, presence of symptoms, age, semm cholesterol and BMI. The relative risk (RR) was calculated for parameters of significant influence. To evaluate a cut-off value for tumour SIZC causing symptoms a receiver operating characteristics (ROC) tune regarding sensitivity and speaficlty for association between tomour six and symptoms was wed

RESULTS: Out of 735 radical nephrectomies, the pT3 tumours were 3 I I. In 8 cases the pathological data to classify the tumour in one of the 4 groups were lacking. Two patients were lost to follow up. Therefore, the evaluable patients were 30 I. The mean age was 60.0 years. Mean follow up was 49.3 months (range O-216). Groups 1, 2 and 3 had the same prognosis (p=O.2). A significant worse prognosis was demonstrated in group 4. The diameter, also, had a prognostic significance and a 6 cm cut off point maximized the differences in cancer specific survival rate (HR 1.7; p
RESULTS: Mean age war 62 yew\ (range 16.88). 150:6X4 (21.9%) patlent\ presented wth s,gn\ and/or symptoms suspicious for cancer. the remaining 534 (7X. 1%) were free of tumour associated symptoms. In patients with incidentally detected RCC, the median turnour diameter was 4.lcm compared to hem in symptomatx patients (p
CONCLUSIONS: This study shows that a RCC with the invasion of the renal sinus fat can be classified as pT3. In the pT3 category the prognostic factor that independently affects the cause specific survival is the involvement of both venous and perinephric structures.

CONCLUSIONS: Tumours larger than 5 cm were significantly more likely fo cause symptoma compared to smaller cancers m our series. Patients presenting with symptoms suspicious for cancer at diagnosis of RCC have a 1.X.fold higher risk to die from cancer compared to patients without cymptoms. Despite the increased incidence of RCC in oheae patients. overweight does not impact on the prognovs of pat,ent? wth renal cell carcinoma m our ser,ei

European Urology Supplements

2 (2003) No. 1, pp. 138