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Modeling Spontaneous Metastatic Renal Cell Carcinoma (mRCC) in Mice Following Nephrectomy
Published on: April 29, 2014
Renal cell carcinoma clinically involving adjacent organs: experience with aggressive surgical management
Vitaly Margulis1, Ricardo F Sánchez-Ortiz, Pheroze Tamboli
1Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Background:
Historically, patients with nonmetastatic renal cell carcinoma (RCC) involving adjacent organs have been considered inoperable and incurable. The oncologic efficacy of an aggressive surgical approach was evaluated in a selected subpopulation of RCC patients. Further, an attempt was made to define the clinical and pathologic characteristics predictive of surgical failure.
Methods:
With Institutional Review Board approval, the institutional nephrectomy database of 3470 patients treated at MD Anderson Cancer Center from 1990 to 2006 was searched for RCC patients treated with radical nephrectomy and resection of at least 1 adjacent organ thought to be directly involved by RCC. Patients with nonmetastatic RCC and a minimum follow-up of 6 months were included in the analysis.
Results:
In all, 30 patients with clinical T4NxM0 RCC and median follow-up of 32.3 months (range, 8.5-140.1) met the study inclusion criteria and comprise the dataset for the analysis. On pathologic evaluation 60% of patients were clinically overstaged, as only 12 (40%) of 30 patients demonstrated direct invasion into adjacent organs resected. None of the clinical tumor characteristics predicted a finding of pathologic T4 RCC. Nodal involvement and pathologic T stage were significant independent predictors of disease recurrence (hazard ratio [HR] 3.726, P = .043, and HR 2.414, P = .045, respectively) and cancer-specific survival (HR 17.145, P = .002, and HR 3.791, P = .024, respectively). Disease recurred in 11 of 18 (61.1%) of
Conclusions:
True pathologic involvement of adjacent organs by RCC cannot be predicted from pre- or intraoperative parameters. A significant proportion of patients clinically suspected of having T4 RCC are downstaged, and benefit from aggressive surgical resection with en bloc removal of involved organs.
Insights
Aggressive surgery for renal cell carcinoma (RCC) involving adjacent organs is effective, even when initial staging suggests otherwise. Pathologic T stage and nodal status predict recurrence and survival in these complex RCC cases.
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Historically, advanced renal cell carcinoma (RCC) with adjacent organ involvement was deemed inoperable.
- This study evaluates the oncologic outcomes of aggressive surgical management in select RCC patients.
Purpose of the Study:
- To assess the efficacy of radical nephrectomy and adjacent organ resection in nonmetastatic RCC.
- To identify clinical and pathologic factors predicting surgical outcomes in T4 RCC.
Main Methods:
- Retrospective review of 3470 RCC patients from 1990-2006.
- Inclusion criteria: nonmetastatic RCC with radical nephrectomy and resection of at least one adjacent organ, with a minimum 6-month follow-up.
- Analysis of 30 patients with clinical T4NxM0 RCC.
Main Results:
- 60% of patients initially suspected of T4 RCC were downstaged pathologically.
- Nodal status and pathologic T stage were significant predictors of recurrence and cancer-specific survival.
- Disease recurrence rates were 61.1% for
Conclusions:
- Pre- and intraoperative parameters cannot reliably predict true pathologic involvement of adjacent organs in RCC.
- Many patients clinically staged as T4 RCC benefit from aggressive surgical resection, including en bloc removal of involved organs.
