cT1腎細胞癌に対する腹腔鏡下/ロボット支援腎部分切除術後にpT3aにUpstageした症例の予後因子

Abstract

Upstaging to pT3a is rare after partial nephrectomy for cT1 renal cell carcinoma (RCC), and its prognosis is reported to be poor. Of 389 patients with cT1 RCC who underwent laparoscopic/robotic assisted partial nephrectomy between 2011-2022, 27 were diagnosed with pT3a. Upstage was observed in 3.6% of patients with cT1a and 19% with cT1b. The median preoperative diameter was 43 mm in the upstaged tumors. One local and five distant metastatic recurrences occurred during the median follow-up period of 59 months, with a median time to distant recurrence of 30 months. Fuhrman grade ≥3 was identified as a significant factor for distant metastatic recurrence. The metastasis-free survival, cancers pecific survival, and overall survival at five years postoperatively were 75. 7%, 96. 2%, and 88. 1%, respectively. Among the upstaged patients, those with higher Fuhrman grade should be carefully monitored for recurrence.