Predictive Factor Analysis And Survival Analysis Of Postoperative PT3a Upstaging In CT1 Renal Cell Carcinoma

ObjectiveClinical staging is critical for treatment decisions in patients with renal cell carcinoma(RCC).Some RCCs were preoperatively staged as cT1,but postoperative tumors were found to invade fat or renal veins,which were actually pT3 a,leading to a pathological upstaging in the tumor.The aim of this study was to determine the predictive factors of RCC upstaging rate,progression,and survival in patients with and without upstaging in patients undergoing surgery for cT1.MethodsWe collected the data of patients with renal tumor cT1 who underwent pathological diagnosis in the Department of Urology,Second Hospital of Tianjin Medical University from January 2010 to December 2016,and chose pT3 a upstaging patients after surgery to add to our research.In analyzing the clinical characteristics of patients,the Mann–Whitney U test was used to study continuous variables,and the chi-square test was used to study categorical variables.Multivariate logistic regression was used to analyze predictors of upstaging,and Cox proportional hazard regression was used to estimate the recurrence hazard ratio.The nomogram is used to to build the predictive model.ResultsIn the 1376 patients with cT1 renal tumors,75 patients were observed to have a postoperative upstaging to pT3 a,accounting for 5.5% of all patients.Univariate analysis and multivariate analysis showed that there were 6 potential predictors of postoperative upstaging in renal cell carcinoma,ie,the older,with clinical symptoms associated with tumors,larger tumors,high Fuhrman grading,CT findings of tumor necrosis,and irregular tumor edge.The 3-year and 5-year RFS probabilities of the upstaging patients were 76.0% and 73.3%,respectively,and the 3-year and 5-year RFS probabilities of the un-increased patients were 92.9% and 91.1%,respectively(Log Rank,p<0.01).The multivariate proportional hazards model demonstrated that pT3 a upstaging was an independent risk factor for relapse-free survival(HR,2.550;95% CI,1.577-4.124;p<0.01).ConclusionsThe rate of pT3 a upstaging in cT1 renal cell carcinoma in our hospital was not negligible(5.5%),and postoperative ascending period was an independent influencing factor for the increased risk of recurrence.Independent predictors of postoperative pT3 a upstaging in patients with cT1 renal cell carcinoma included the older,with clinical symptoms associated with tumors,larger tumors,high Fuhrman grading,CT findings of tumor necrosis,and irregular tumor edge.We developed a nomogram in conjunction with these predictors.This model can provide decision-making for patient counseling and treatment before providing and receiving RCC treatment.The model prediction accuracy is good and has a certain promotion value in the Chinese population,but it also needs extensive clinical practice to test its accuracy.PN should routinely remove all adipose tissue indicated by renal tumors,which may contribute to accurate pathological staging after surgery and may reduce the risk of tumor residual and local recurrence.