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Introduction: Small renal masses are primarily managed with partial nephrectomy. A small number of patients who undergoing partial nephrectomy for clinical T1a renal mass will be upstaged to T3a renal cell carcinoma (RCC) secondary to perirenal fat invasion on final pathologic evaluation. The aim of this study was to evaluate oncologic outcomes in clinical T1a tumors which remain pathological T1a compared to tumors which were upstaged to pathologic T3a.
Material and Methods: A retrospective database was created of all patients with RCC. A query was then performed to identify patients who underwent surgery for a solitary clinical T1a renal mass. Preoperative factors associated with clinical T1a lesions were studied using a multivariate logistic regression analysis. Patients with pathologic T1a RCC were compared to those upstaged to T3a for differences in overall mortality and disease-free survival using log-rank test of Kaplan-Meier survival estimates.
Results: The records of 468 patients who underwent surgical intervention for RCC were reviewed of which 213 (46%) patients were identified as clinical T1a. Of the 213 patients with cT1a, 19 (9%) were upstaged to pathologic T3a. Overall mortality analysis revealed that 5 of the 19 patients with pT3a (26%) compared to 36 of the 172 patients with pT1a (19%). Kaplan-Meier survival estimates revealed there to be no statistical differences in overall mortality between the two groups.
Conclusions: Clinically diagnosed T1a tumors which are upstaged to pathologic T3a secondary to perirenal fat invasion have similar oncologic outcomes when compared to clinically diagnosed T1a tumors which remain pathologic T1a.