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Seung Choul Yang - One of the best experts on this subject based on the ideXlab platform.
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comparison of the prognosis between pt3a only patients with Perirenal Fat invasion and t1 t2 patients respectively is it necessary to revice state t3a
Korean Journal of Urology, 2006Co-Authors: Woong Kyu Han, Yong Seong Lee, Koon Ho Rha, Sung Jun Hong, Hyung Joon Kim, Seung Choul YangAbstract:Purpose: As compared with pathologic stages T1 and T2, we aimed to investigate the difference of the prognosis for the patients with Perirenal Fat invasion (pT3a), and the patients were divided into two groups by the tumor size of 7cm. Materials and Methods: Of the 503 patients who underwent an operation for renal cell carcinoma between June 1995 and April 2004, we retro- spectively reviewed the records of 455 patients with T1, T2 and T3a stage renal cell carcinoma without adrenal invasion. We evaluated the cell type, the multifocality of the tumor, the nuclear grade, the presence of a sar- comatoid component and the coagulative histologic necrosis. We divided the patients with pT3a renal cell carcinoma into two groups according to the tumor size of 7cm (Group 1; 7cm pT3a, Group 2; ĥ7cm pT3a). The overall survival was estimated using the Kaplan-Meier method and the log-rank test. We used Students s t-test to compare each factors between groups 1 and 2 and the T1 and T2 groups, respectively. The prognostic factors that had an influence on survival were estimated using the Cox proportional hazard regression model in each group. Results: After the exclusion criteria (the presence of adrenal invasion in pT3a patients) were applied, 24 patients were in group 1, 23 patients were in group 2, 328 patients had pT1 disease and 80 patients had pT2 disease. The median follow-up was 45.4 months. When group 1 was compared to the pT1 group, there was no significantly difference of the estimated survival (p=0.21). There was a similar result when comparing the esti- mated survival between group 2 and the pT2 group (p=0.80). Conclusions: No significant difference exists for the disease specific survival when patients with pT3a disease (Groups 1 and 2) are compared to the patients with either pT1 or pT2 disease. These findings reveal that patients with pT3a disease without adrenal invasion have similar outcomes to patients with either with pT1 or pT2 disease. Therefore, our result sug- gests that pT3a tumor should be re-classified according to tumor size into
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Perirenal Fat invasion pt3a in renal cell carcinoma less than 4cm in size ct1a analysis of the prognostic and pathological implications
Korean Journal of Urology, 2006Co-Authors: Woong Kyu Han, Young Joon Byun, Yong Seong Lee, Yong Soo Kim, Koon Ho Rha, Sung Jun Hong, Seung Choul YangAbstract:Purpose: To investigate the incidence and histopathological factors of Perirenal Fat invasion (pT3a) in cT1a renal cell carcinomas. The implication for postoperative Perirenal Fat invasion, as a prognostic factor in patients with tumors less than 4cm tumor in size is also discussed. Materials and Methods: Of 503 patients who underwent an operation for a renal cell carcinoma at our institution, between June 1995 and April 2004, we retrospectively reviewed the records of 176 with T1a renal cell carcinomas. We evaluated the pathological grade, cell type, tumor size, location and incidence of Perirenal Fat invasion using the Fisher's exact test. The overall survival was estimated using the Kaplan-Meier method and log-rank test, and the prognostic factors influencing the survival were estimated using the Cox proportional hazard regression model. Results: In this study, a radical nephrectomy was performed in 128 men and 48 women, with a mean age of 54.6 years, ranging from 23 to 77. The mean follow-up was 31.3 months, ranging from 6 to 106 months. The average size of the renal cell carcinomas was 3.0cm, ranging from 1 to 4cm. The incidence of Perirenal Fat invasion in the T1a renal cell carcinomas was 5.7% (n=10). The nuclear grade (p<0.001) was a statistically significant factor in the incidence of postoperative Perirenal Fat invasion. Conclusions: In the patients with a renal cell carcinoma less than 4cm in size (cT1a), those in the postoperative Perirenal Fat invasion group had a significantly poorer prognosis. The tumor size and Fuhrman nuclear grade were implicated in the incidence of Perirenal Fat invasion in the T1a renal cell carcinomas. Therefore, in the case of nephron sparing surgery, more precise preoperative staging of the primary tumor is required. (Korean J Urol 2006;47:596-600) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ
Asa H Everhov - One of the best experts on this subject based on the ideXlab platform.
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Perirenal Fat surface area and oncologic outcome in elective colon cancer surgery
Diseases of The Colon & Rectum, 2021Co-Authors: Sara E Eckberg, Martin Dahlberg, Olof Der S Hagopian, Parastou Farahnak, Gabriel Sandblom, Caroline Nordenvall, Asa H EverhovAbstract:Background Central obesity is associated with surgical difficulties, but few studies explore the relationship with long-term results after colon cancer surgery. Objective The purpose of this study was to investigate the association between Perirenal Fat surface area, a proxy for total visceral Fat, and oncologic outcome after intestinal resection for colon cancer. Design We investigated the association between Perirenal Fat surface area (exposure) on recurrence and death (outcome) in patients undergoing surgery with curative intent for colon cancer. Settings The study was conducted at Stockholm South General Hospital, serving a population of 600,000. Patients Patients (N = 733) without metastases at diagnosis who had a preoperative CT and had undergone elective colon resection between 2006 and 2016 were included. Main outcome measures We compared overall survival, recurrence-free survival, and cause-specific survival by Perirenal Fat surface area. Results Patients with high Perirenal Fat surface area (fourth quartile) had more often left-sided tumors (45% vs 32% in the first quartile) and experienced more postoperative complications (29% vs 13%), but there were no differences in pathologic T and N stage, radicality of surgery, or adjuvant chemotherapy treatment. Overall survival decreased by increasing cancer stage but was not different between Perirenal Fat surface area categories. The HR for recurrence-free survival per centimeter squared increase in Perirenal Fat surface area was 1.00 (95% CI, 0.99-1.01) adjusted for age, sex, ASA category, tumor location, and postoperative complication Clavien-Dindo ≥2. The cumulative incidence of recurrence with death as a competing risk was not statistically different between Perirenal Fat surface area categories (p = 0.06). Subgroup analyses showed a nonsignificant tendency for men with low Perirenal Fat surface area to have a lower risk of recurrence and women a higher risk. Limitations In all register-based studies there can be randomly distributed errors. The results can only be generalized to colon resections. Our cohort ranged over a large year span. Conclusions We found no association between Perirenal Fat surface area and overall survival, recurrence-free survival, or cause-specific cumulative incidence of recurrence in patients undergoing colon resection for cancer. See Video Abstract at http://links.lww.com/DCR/B326. La superficie de grasa perirrenal y el resultado oncolgico en ciruga electiva de cncer de colon ANTECEDENTES:La obesidad central esta asociada con dificultades quirurgicas, pero pocos estudios exploran la relacion de los resultados a largo plazo despues de cirugia de cancer de colon.OBJETIVO:Investigar la asociacion entre la superficie de la grasa perirrenal, como un indicador de la grasa visceral total y el resultado oncologico despues de una reseccion intestinal por cancer de colon.DISENO:Se estudio la asociacion entre el area de la superficie de la grasa perirrenal (expuesta) con la recurrencia y la muerte (resultado) de pacientes sometidos a cirugia con intencion curativa por cancer de colon.AJUSTES:Atencion brindada por el Hospital General del Sur de Estocolmo a una poblacion de 600,000 habitantes.PACIENTES:Aquellos pacientes sin metastasis (n = 733) en el momento del diagnostico que tuvieron una tomografia computada preoperatoria y que se sometieron a una reseccion electiva de colon entre 2006-2016.PRINCIPALES MEDIDAS DE RESULTADO:Comparamos la sobrevida general, la sobrevida libre de recurrencia y la sobrevida especifica de la causa, por area de superficie de grasa perirrenal.RESULTADOS:Los pacientes con una mayor area de superficie de grasa perirrenal (cuarto cuartil) tuvieron mas frecuentemente tumores del lado izquierdo (45% frente a 32% en el primer cuartil) y sufrieron mas complicaciones postoperatorias (29% frente a 13%), pero no hubieron diferencias en el Estadio patologico T y N, ni en lo radical de la cirugia o del tratamiento de quimioterapia adyuvante. La supervivencia general disminuyo al aumentar el estadio del cancer, pero no fue diferente entre las categorias de area de superficie grasa perirrenal. La razon de riesgo para la sobrevida libre de recurrencia por aumento de cm2 en el area de la superficie grasa perirrenal fue de 1.00 (intervalo de confianza del 95%: 0.99-1.01) ajustada por edad, sexo, categoria de la Sociedad Americana de Anestesiologos, ubicacion del tumor y complicacion postoperatoria segun Clavien-Dindo ≥ 2) La incidencia acumulada de recurrencia con muerte como un riesgo competitivo no fue estadisticamente diferente entre las categorias de area de superficie grasa perirrenal (p = 0.06). Los analisis de subgrupos mostraron una tendencia no significativa para que los hombres con un area de superficie menor en grasa perirrenal tengan un menor riesgo de recurrencia y las mujeres un mayor riesgo.LIMITACIONES:En todos los estudios basados en registros puede haber errores distribuidos aleatoriamente. Los resultados solo pueden generalizarse a resecciones de colon. Nuestra cohorte oscilo durante un gran lapso de anos.CONCLUSIONES:No se encontro asociacion entre el area de superficie de la grasa perirrenal y la sobrevida general, ni con la sobrevida libre de recurrencia o la incidencia acumulada de recurrencia especifica de la causa en pacientes sometidos a reseccion de colon por cancer. Consulte Video Resumen en http://links.lww.com/DCR/B326. (Traduccion-Dr Xavier Delgadillo).
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Perirenal Fat surface area as a risk factor for perioperative difficulties and 30 day postoperative complications in elective colon cancer surgery
Colorectal Disease, 2018Co-Authors: Der O Hagopian, Martin Dahlberg, Parastou Farahnak, Gabriel Sandblom, Caroline Nordenvall, Goran Heinius, J Nordberg, J Gustafsson, Asa H EverhovAbstract:AIM Visceral obesity is associated with perioperative and postoperative complications in colorectal surgery. We aimed to investigate the association between the Perirenal Fat surface area (PRF) and postoperative complications. METHOD Data on 610 patients undergoing curative, elective colon cancer resection between 2006 and 2016 at Stockholm South General Hospital were retrieved from a local quality register. We assessed perioperative and postoperative outcomes using a multinomial regression model adjusted for age, sex, American Society of Anesthesiologists classification and surgical approach (open/laparoscopy) in relation to PRF. RESULTS PRF could be measured in 605 patients; the median area was 24 cm2 . Patients with PRF ≥ 40 cm2 had longer operation time (median 223 vs 184 min), more intra-operative bleeding (250 vs 125 ml), reoperations (11% vs 6%), surgical complications (27% vs 13%) and nonsurgical infectious complications (16% vs 9%) than patients with PRF < 40 cm2 , but there were no differences in the need for intensive care or duration of hospital stay. The multivariate analyses revealed an increased risk of any complication [OR 1.68 (95% CI 1.1-2.6)], which was even more pronounced for moderate complications [Clavien-Dindo II, OR 2.14 (CI 1.2-2.4]; Clavien-Dindo III, OR 2.35 (CI 1.0-5.5)] in patients with PRF ≥ 40 vs < 40 cm2 . The absolute risk of complications was similar in men and women with PRF ≥ 40 cm2 . CONCLUSION PRF, an easily measured indirect marker of visceral obesity, was associated with overall and moderate complications in men and women and could serve as a useful tool in the assessment of preoperative risk.
Sabine Brookmanmay - One of the best experts on this subject based on the ideXlab platform.
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evaluation of the prognostic significance of Perirenal Fat invasion and tumor size in patients with pt1 pt3a localized renal cell carcinoma in a comprehensive multicenter study of the corona project can we improve prognostic discrimination for patients with stage pt3a tumors
European Urology, 2015Co-Authors: Sabine Brookmanmay, Matthias May, Richard Zigeuner, Luca Cindolo, Ingmar Wolff, Georg C Hutterer, Luigi Schips, Ottavio De Cobelli, Bernardo RoccoAbstract:Abstract Background The current TNM system for renal cell carcinoma (RCC) merges Perirenal Fat invasion (PFI) and renal vein invasion (RVI) as stage pT3a despite limited evidence concerning their prognostic equivalence. In addition, the prognostic value of PFI compared to pT1–pT2 tumors remains controversial. Objective To analyze the prognostic significance of PFI, RVI, and tumor size in pT1–pT3a RCC. Design, setting, and participants Data for 7384 pT1a–pT3a RCC patients were pooled from 12 centers. Patients were grouped according to stages and PFI/RVI presence as follows: pT1–2N0M0 ( n =6137; 83.1%), pT3aN0M0 + PFI ( n =1036; 14%), and pT3aN0M0 (RVI ± PFI; n =211; 2.9%). Intervention Radical nephrectomy or nephron-sparing surgery (NSS) (1992–2010). Outcome measurements and statistical analysis Cancer-specific survival was estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional-hazards regression models, as well as sensitivity and discrimination analyses, were used to evaluate the impact of clinicopathologic parameters on cancer-specific mortality (CSM). Results and limitations Compared to stage pT1–2, patients with stage pT3a RCC were significantly more often male (59.4% vs 53.1%) and older (64.9 vs 62.1 yr), more often had clear cell RCC (85.2% vs 77.7%), Fuhrman grade 3–4 (29.4% vs 13.4%), and tumor size >7cm (39.1% vs 13%), and underwent NSS less often (7.5% vs 36.6%; all p p p =0.316). Tumor size instead enhanced CSM by 7% per cm in stage pT3a (HR 1.07; p Conclusions Since the prognostic impact of PFI and RVI on CSM seems to be comparable, merging both as stage pT3a RCC might be justified. Enhanced prognostic discrimination of stage pT3a RCC appears to be possible by applying a tumor size cutoff of 7cm within an alternative staging system. Patient summary Prognosis prediction for patients with localized renal cell carcinoma up to stage pT3a can be enhanced by including tumor size with a cutoff of 7cm as an additional parameter in the TNM classification system.
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prognostic significance of Perirenal Fat invasion and tumor size in pt1 to pt3a renal cell carcinoma results of a comprehensive multicenter study of the corona project can we improve prognostic discrimination of patients with stage pt3a tumors
Journal of Clinical Oncology, 2015Co-Authors: Sabine Brookmanmay, Matthias May, Richard Zigeuner, Luca Cindolo, Shahrokh F Shariat, Manfred P Wirth, Sven GuniaAbstract:416 Background: The renal cell carcinoma (RCC) TNM system merges Perirenal Fat invasion (PFI) and renal vein invasion (RVI) as stage pT3a despite limited evidence concerning their prognostic equivalence. Additionally, the prognostic value of PFI compared to pT1-pT2 tumors remains controversial. Methods: Data of 7,595 pT1a-pT3a RCC patients undergoing radical nephrectomy or nephron-sparin surgery were pooled from 12 European and U.S. centers (1999-2010). Patients were grouped according to stages and presence of PFI/RVI, i.e., pT1-2N0M0 (n=6,137; 80.8%), pT3aN0M0+PFI (n=1,036; 13.6%), and pT3aN0M0 (RVI±PFI; n=422; 5.6%). Cancer-specific survival (CSS) was estimated by Kaplan-Meier method. Univariate and multivariable Cox proportional-hazards regression models, sensitivity and discrimination analyses were conducted to evaluate the impact of clinico-pathological parameters on cancer-specific mortality (CSM). Results: Compared to stage pT1-2, patients staged pT3a were significantly more frequently male (58.9 v...
Caroline Nordenvall - One of the best experts on this subject based on the ideXlab platform.
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Perirenal Fat surface area and oncologic outcome in elective colon cancer surgery
Diseases of The Colon & Rectum, 2021Co-Authors: Sara E Eckberg, Martin Dahlberg, Olof Der S Hagopian, Parastou Farahnak, Gabriel Sandblom, Caroline Nordenvall, Asa H EverhovAbstract:Background Central obesity is associated with surgical difficulties, but few studies explore the relationship with long-term results after colon cancer surgery. Objective The purpose of this study was to investigate the association between Perirenal Fat surface area, a proxy for total visceral Fat, and oncologic outcome after intestinal resection for colon cancer. Design We investigated the association between Perirenal Fat surface area (exposure) on recurrence and death (outcome) in patients undergoing surgery with curative intent for colon cancer. Settings The study was conducted at Stockholm South General Hospital, serving a population of 600,000. Patients Patients (N = 733) without metastases at diagnosis who had a preoperative CT and had undergone elective colon resection between 2006 and 2016 were included. Main outcome measures We compared overall survival, recurrence-free survival, and cause-specific survival by Perirenal Fat surface area. Results Patients with high Perirenal Fat surface area (fourth quartile) had more often left-sided tumors (45% vs 32% in the first quartile) and experienced more postoperative complications (29% vs 13%), but there were no differences in pathologic T and N stage, radicality of surgery, or adjuvant chemotherapy treatment. Overall survival decreased by increasing cancer stage but was not different between Perirenal Fat surface area categories. The HR for recurrence-free survival per centimeter squared increase in Perirenal Fat surface area was 1.00 (95% CI, 0.99-1.01) adjusted for age, sex, ASA category, tumor location, and postoperative complication Clavien-Dindo ≥2. The cumulative incidence of recurrence with death as a competing risk was not statistically different between Perirenal Fat surface area categories (p = 0.06). Subgroup analyses showed a nonsignificant tendency for men with low Perirenal Fat surface area to have a lower risk of recurrence and women a higher risk. Limitations In all register-based studies there can be randomly distributed errors. The results can only be generalized to colon resections. Our cohort ranged over a large year span. Conclusions We found no association between Perirenal Fat surface area and overall survival, recurrence-free survival, or cause-specific cumulative incidence of recurrence in patients undergoing colon resection for cancer. See Video Abstract at http://links.lww.com/DCR/B326. La superficie de grasa perirrenal y el resultado oncolgico en ciruga electiva de cncer de colon ANTECEDENTES:La obesidad central esta asociada con dificultades quirurgicas, pero pocos estudios exploran la relacion de los resultados a largo plazo despues de cirugia de cancer de colon.OBJETIVO:Investigar la asociacion entre la superficie de la grasa perirrenal, como un indicador de la grasa visceral total y el resultado oncologico despues de una reseccion intestinal por cancer de colon.DISENO:Se estudio la asociacion entre el area de la superficie de la grasa perirrenal (expuesta) con la recurrencia y la muerte (resultado) de pacientes sometidos a cirugia con intencion curativa por cancer de colon.AJUSTES:Atencion brindada por el Hospital General del Sur de Estocolmo a una poblacion de 600,000 habitantes.PACIENTES:Aquellos pacientes sin metastasis (n = 733) en el momento del diagnostico que tuvieron una tomografia computada preoperatoria y que se sometieron a una reseccion electiva de colon entre 2006-2016.PRINCIPALES MEDIDAS DE RESULTADO:Comparamos la sobrevida general, la sobrevida libre de recurrencia y la sobrevida especifica de la causa, por area de superficie de grasa perirrenal.RESULTADOS:Los pacientes con una mayor area de superficie de grasa perirrenal (cuarto cuartil) tuvieron mas frecuentemente tumores del lado izquierdo (45% frente a 32% en el primer cuartil) y sufrieron mas complicaciones postoperatorias (29% frente a 13%), pero no hubieron diferencias en el Estadio patologico T y N, ni en lo radical de la cirugia o del tratamiento de quimioterapia adyuvante. La supervivencia general disminuyo al aumentar el estadio del cancer, pero no fue diferente entre las categorias de area de superficie grasa perirrenal. La razon de riesgo para la sobrevida libre de recurrencia por aumento de cm2 en el area de la superficie grasa perirrenal fue de 1.00 (intervalo de confianza del 95%: 0.99-1.01) ajustada por edad, sexo, categoria de la Sociedad Americana de Anestesiologos, ubicacion del tumor y complicacion postoperatoria segun Clavien-Dindo ≥ 2) La incidencia acumulada de recurrencia con muerte como un riesgo competitivo no fue estadisticamente diferente entre las categorias de area de superficie grasa perirrenal (p = 0.06). Los analisis de subgrupos mostraron una tendencia no significativa para que los hombres con un area de superficie menor en grasa perirrenal tengan un menor riesgo de recurrencia y las mujeres un mayor riesgo.LIMITACIONES:En todos los estudios basados en registros puede haber errores distribuidos aleatoriamente. Los resultados solo pueden generalizarse a resecciones de colon. Nuestra cohorte oscilo durante un gran lapso de anos.CONCLUSIONES:No se encontro asociacion entre el area de superficie de la grasa perirrenal y la sobrevida general, ni con la sobrevida libre de recurrencia o la incidencia acumulada de recurrencia especifica de la causa en pacientes sometidos a reseccion de colon por cancer. Consulte Video Resumen en http://links.lww.com/DCR/B326. (Traduccion-Dr Xavier Delgadillo).
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Perirenal Fat surface area as a risk factor for perioperative difficulties and 30 day postoperative complications in elective colon cancer surgery
Colorectal Disease, 2018Co-Authors: Der O Hagopian, Martin Dahlberg, Parastou Farahnak, Gabriel Sandblom, Caroline Nordenvall, Goran Heinius, J Nordberg, J Gustafsson, Asa H EverhovAbstract:AIM Visceral obesity is associated with perioperative and postoperative complications in colorectal surgery. We aimed to investigate the association between the Perirenal Fat surface area (PRF) and postoperative complications. METHOD Data on 610 patients undergoing curative, elective colon cancer resection between 2006 and 2016 at Stockholm South General Hospital were retrieved from a local quality register. We assessed perioperative and postoperative outcomes using a multinomial regression model adjusted for age, sex, American Society of Anesthesiologists classification and surgical approach (open/laparoscopy) in relation to PRF. RESULTS PRF could be measured in 605 patients; the median area was 24 cm2 . Patients with PRF ≥ 40 cm2 had longer operation time (median 223 vs 184 min), more intra-operative bleeding (250 vs 125 ml), reoperations (11% vs 6%), surgical complications (27% vs 13%) and nonsurgical infectious complications (16% vs 9%) than patients with PRF < 40 cm2 , but there were no differences in the need for intensive care or duration of hospital stay. The multivariate analyses revealed an increased risk of any complication [OR 1.68 (95% CI 1.1-2.6)], which was even more pronounced for moderate complications [Clavien-Dindo II, OR 2.14 (CI 1.2-2.4]; Clavien-Dindo III, OR 2.35 (CI 1.0-5.5)] in patients with PRF ≥ 40 vs < 40 cm2 . The absolute risk of complications was similar in men and women with PRF ≥ 40 cm2 . CONCLUSION PRF, an easily measured indirect marker of visceral obesity, was associated with overall and moderate complications in men and women and could serve as a useful tool in the assessment of preoperative risk.
Woong Kyu Han - One of the best experts on this subject based on the ideXlab platform.
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comparison of the prognosis between pt3a only patients with Perirenal Fat invasion and t1 t2 patients respectively is it necessary to revice state t3a
Korean Journal of Urology, 2006Co-Authors: Woong Kyu Han, Yong Seong Lee, Koon Ho Rha, Sung Jun Hong, Hyung Joon Kim, Seung Choul YangAbstract:Purpose: As compared with pathologic stages T1 and T2, we aimed to investigate the difference of the prognosis for the patients with Perirenal Fat invasion (pT3a), and the patients were divided into two groups by the tumor size of 7cm. Materials and Methods: Of the 503 patients who underwent an operation for renal cell carcinoma between June 1995 and April 2004, we retro- spectively reviewed the records of 455 patients with T1, T2 and T3a stage renal cell carcinoma without adrenal invasion. We evaluated the cell type, the multifocality of the tumor, the nuclear grade, the presence of a sar- comatoid component and the coagulative histologic necrosis. We divided the patients with pT3a renal cell carcinoma into two groups according to the tumor size of 7cm (Group 1; 7cm pT3a, Group 2; ĥ7cm pT3a). The overall survival was estimated using the Kaplan-Meier method and the log-rank test. We used Students s t-test to compare each factors between groups 1 and 2 and the T1 and T2 groups, respectively. The prognostic factors that had an influence on survival were estimated using the Cox proportional hazard regression model in each group. Results: After the exclusion criteria (the presence of adrenal invasion in pT3a patients) were applied, 24 patients were in group 1, 23 patients were in group 2, 328 patients had pT1 disease and 80 patients had pT2 disease. The median follow-up was 45.4 months. When group 1 was compared to the pT1 group, there was no significantly difference of the estimated survival (p=0.21). There was a similar result when comparing the esti- mated survival between group 2 and the pT2 group (p=0.80). Conclusions: No significant difference exists for the disease specific survival when patients with pT3a disease (Groups 1 and 2) are compared to the patients with either pT1 or pT2 disease. These findings reveal that patients with pT3a disease without adrenal invasion have similar outcomes to patients with either with pT1 or pT2 disease. Therefore, our result sug- gests that pT3a tumor should be re-classified according to tumor size into
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Perirenal Fat invasion pt3a in renal cell carcinoma less than 4cm in size ct1a analysis of the prognostic and pathological implications
Korean Journal of Urology, 2006Co-Authors: Woong Kyu Han, Young Joon Byun, Yong Seong Lee, Yong Soo Kim, Koon Ho Rha, Sung Jun Hong, Seung Choul YangAbstract:Purpose: To investigate the incidence and histopathological factors of Perirenal Fat invasion (pT3a) in cT1a renal cell carcinomas. The implication for postoperative Perirenal Fat invasion, as a prognostic factor in patients with tumors less than 4cm tumor in size is also discussed. Materials and Methods: Of 503 patients who underwent an operation for a renal cell carcinoma at our institution, between June 1995 and April 2004, we retrospectively reviewed the records of 176 with T1a renal cell carcinomas. We evaluated the pathological grade, cell type, tumor size, location and incidence of Perirenal Fat invasion using the Fisher's exact test. The overall survival was estimated using the Kaplan-Meier method and log-rank test, and the prognostic factors influencing the survival were estimated using the Cox proportional hazard regression model. Results: In this study, a radical nephrectomy was performed in 128 men and 48 women, with a mean age of 54.6 years, ranging from 23 to 77. The mean follow-up was 31.3 months, ranging from 6 to 106 months. The average size of the renal cell carcinomas was 3.0cm, ranging from 1 to 4cm. The incidence of Perirenal Fat invasion in the T1a renal cell carcinomas was 5.7% (n=10). The nuclear grade (p<0.001) was a statistically significant factor in the incidence of postoperative Perirenal Fat invasion. Conclusions: In the patients with a renal cell carcinoma less than 4cm in size (cT1a), those in the postoperative Perirenal Fat invasion group had a significantly poorer prognosis. The tumor size and Fuhrman nuclear grade were implicated in the incidence of Perirenal Fat invasion in the T1a renal cell carcinomas. Therefore, in the case of nephron sparing surgery, more precise preoperative staging of the primary tumor is required. (Korean J Urol 2006;47:596-600) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ
