Clinical Outcomes of Patients with pT2b and Small Size pT3a Renal Cell Carcinomas Are Similar
Hua Zhong, Kristopher Attwood, Ying Huang, Bo Xu. Cancer Institute of New Jersey, Robert Wood Johnson Medical School, UMDNJ, New Brunswick, NJ; Roswell Park Cancer Institute, Buffalo, NY; State University of New York at Buffalo, Buffalo, NY
Background: Tumor size is one of the critical parameters for pathological staging in organ confined tumors and it is less significant in locally advanced tumors. This study aimed to compare clinicopathologic features of large pT2 (pT2b, >10cm) and small pT3a (≤7cm, designated as pT3as in the current study) renal cell carcinomas (RCCs).
Design: Sixty cases of pT2b and 87 cases of pT3as RCCs were identified between 1995 and 2011 by using 2010 UICC/AJCC TNM staging system. Their pathological features were reviewed. Patient clinical outcomes were followed-up by NCI-designated Comprehensive Cancer Center-based registry plus reviewing medical records.
Results: Median follow-up was 36.8 months (IQR: 18.0 62.5). Compared to pT3as, pT2b was more frequent in younger patients (p<0.001), while lymphovascular invasion (LVI) (p=0.040) and positive surgical margins (p=0.003) were less common with pT2b. A total of 25 pT2b (41.7%) and 37 pT3as (42.5%) patients had died, mostly due to cancer: 21 pT2b (35.0%) and 30 pT3as (34.5%). Frequencies of patients with persistent disease, local recurrence and distant metastasis were similar between two groups. Kaplan-Meier analysis showed no significant differences between the two groups in overall survival (OS), disease specific survival (DSS), progression free survival (PFS) and disease free survival (DFS). The calculated 3-year OS, DSS, PFS and DFS rates (pT2b versus pT3as) were 71.1% vs 65.7%, 75.4% vs 72.3%, 41.2% vs 48.9% and 50.5% vs 58.7%, respectively. In addition, COX proportional hazards regression model demonstrated that Fuhrman nuclear grade was significantly associated with OS (p=0.008), DSS (p=0.002), PFS (p=0.002) and DFS (p=0.003), whereas LVI and surgical margin statuses were associated with PFS. When adjusting for lymph node status, patients with negative lymph node showed more favorable PFS (p=0.002) while pT3as patients in fact had more favorable PFS (p=0.031) and DFS (p=0.045) as compared to pT2b patients.
Conclusions: Although pT2b and pT3as RCCs have certain differences in their clinical and pathological features, the patients' clinical outcomes are essentially similar. The PFS and DFS of patients with pT2b versus pT3as RCCs become statistically significantly different when adjusted for lymph node status.
Category: Genitourinary (including renal tumors)
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 155, Wednesday Afternoon