Defining Tumour Shape Irregularity for Preoperative Risk Stratification of Clinically Localised Renal Cell Carcinoma
Background: Unexpected adverse pathology is a major concern in surgical management of clinically localised renal cell carcinoma (RCC). Further studies are needed to improve preoperative risk stratification. Objective: To define and classify tumour shape irregularity (TSI) based on preoperative imagi...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-02-01
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| Series: | European Urology Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266616832202715X |
| _version_ | 1797944049791926272 |
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| author | Hajime Tanaka Shohei Fukuda Koichiro Kimura Yuki Fukawa Kouhei Yamamoto Hiroshi Fukushima Shingo Moriyama Yosuke Yasuda Sho Uehara Yuma Waseda Soichiro Yoshida Minato Yokoyama Yoh Matsuoka Kazutaka Saito Ukihide Tateishi Steven C. Campbell Yasuhisa Fujii |
| author_facet | Hajime Tanaka Shohei Fukuda Koichiro Kimura Yuki Fukawa Kouhei Yamamoto Hiroshi Fukushima Shingo Moriyama Yosuke Yasuda Sho Uehara Yuma Waseda Soichiro Yoshida Minato Yokoyama Yoh Matsuoka Kazutaka Saito Ukihide Tateishi Steven C. Campbell Yasuhisa Fujii |
| author_sort | Hajime Tanaka |
| collection | DOAJ |
| description | Background: Unexpected adverse pathology is a major concern in surgical management of clinically localised renal cell carcinoma (RCC). Further studies are needed to improve preoperative risk stratification. Objective: To define and classify tumour shape irregularity (TSI) based on preoperative imaging, and to investigate its effect on pathological and oncological outcomes in clinically localised RCC. Design, setting, and participants: We retrospectively analysed 474 patients with cT1-2N0M0 RCC managed by partial or radical nephrectomy. Preoperative dynamic computed tomography was used to define and classify TSI, graded as 1 (completely elliptical shape), 2 (elliptical shape with minor and focal protrusions), or 3 (nonelliptical shape presenting with major and/or extensive protrusions). Intervention: Partial or radical nephrectomy. Outcome measurements and statistical analysis: A logistic regression analysis evaluated the risk factors for pT3a upstaging and Fuhrman grade 3–4. A Cox proportional hazard analysis assessed preoperative variables for recurrence-free survival (RFS). Results and limitations: The median tumour size was 3.5 cm, and 94 patients (20%) had (R)adius (tumour size as maximal diameter), (E)xophytic/endophytic properties of tumour, (N)earness of tumour deepest portion to collecting system or sinus, (A)nterior (a)/posterior (p) descriptor, and (L)ocation relative to polar lines (RENAL) score ≥10. TSI was graded as 1, 2, and 3 in 214 (45%), 151 (32%), and 109 (23%) patients, respectively. Higher TSI was significantly associated with a larger tumour size and a higher RENAL score. Overall, pT3a upstaging and Fuhrman grade 3–4 were observed in 45 (9.5%) and 116 patients (31% in 380 clear cell RCC cases), respectively. The incidence of pT3a upstaging and Fuhrman grade 3–4 was significantly higher in patients with higher TSI (0.5%, 8.6%, and 28% for pT3a upstaging and 12%, 33%, and 60% for Fuhrman grade 3–4 in TSI 1, 2, and 3 groups, respectively). In multivariable analyses, higher TSI was independently associated with adverse pathological outcomes. During the median follow-up of 6.0 yr, 49 patients (10%) developed recurrence. Multivariable analyses demonstrated that older age and higher TSI were independent risk factors for worse RFS. The limitations include the retrospective design. Conclusions: TSI may be a useful adjunct in preoperative risk stratification for adverse pathology and recurrence after surgery in clinically localised RCC. Patient summary: Tumour shape irregularity is significantly associated with unfavourable pathological outcomes, that is, locally advanced stage or high-grade cancer, and with a higher recurrence rate after surgery in patients with clinically localised renal cell carcinoma. Preoperative evaluation of the tumour shape may help in patient counselling and treatment decisions. |
| first_indexed | 2024-04-10T20:33:31Z |
| format | Article |
| id | doaj.art-04de6025cea445dea307c18b2a5b55fe |
| institution | Directory Open Access Journal |
| issn | 2666-1683 |
| language | English |
| last_indexed | 2024-04-10T20:33:31Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Urology Open Science |
| spelling | doaj.art-04de6025cea445dea307c18b2a5b55fe2023-01-25T04:16:27ZengElsevierEuropean Urology Open Science2666-16832023-02-01483643Defining Tumour Shape Irregularity for Preoperative Risk Stratification of Clinically Localised Renal Cell CarcinomaHajime Tanaka0Shohei Fukuda1Koichiro Kimura2Yuki Fukawa3Kouhei Yamamoto4Hiroshi Fukushima5Shingo Moriyama6Yosuke Yasuda7Sho Uehara8Yuma Waseda9Soichiro Yoshida10Minato Yokoyama11Yoh Matsuoka12Kazutaka Saito13Ukihide Tateishi14Steven C. Campbell15Yasuhisa Fujii16Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan; Corresponding author. Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. Tel. +81-3-5803-5295; Fax: +81-3-5803-5295.Department of Urology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Radiology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Pathology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Pathology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Urology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Urology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Urology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Urology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Urology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Urology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Urology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Urology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Urology, Tokyo Medical and Dental University, Tokyo, JapanDepartment of Radiology, Tokyo Medical and Dental University, Tokyo, JapanGlickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USADepartment of Urology, Tokyo Medical and Dental University, Tokyo, JapanBackground: Unexpected adverse pathology is a major concern in surgical management of clinically localised renal cell carcinoma (RCC). Further studies are needed to improve preoperative risk stratification. Objective: To define and classify tumour shape irregularity (TSI) based on preoperative imaging, and to investigate its effect on pathological and oncological outcomes in clinically localised RCC. Design, setting, and participants: We retrospectively analysed 474 patients with cT1-2N0M0 RCC managed by partial or radical nephrectomy. Preoperative dynamic computed tomography was used to define and classify TSI, graded as 1 (completely elliptical shape), 2 (elliptical shape with minor and focal protrusions), or 3 (nonelliptical shape presenting with major and/or extensive protrusions). Intervention: Partial or radical nephrectomy. Outcome measurements and statistical analysis: A logistic regression analysis evaluated the risk factors for pT3a upstaging and Fuhrman grade 3–4. A Cox proportional hazard analysis assessed preoperative variables for recurrence-free survival (RFS). Results and limitations: The median tumour size was 3.5 cm, and 94 patients (20%) had (R)adius (tumour size as maximal diameter), (E)xophytic/endophytic properties of tumour, (N)earness of tumour deepest portion to collecting system or sinus, (A)nterior (a)/posterior (p) descriptor, and (L)ocation relative to polar lines (RENAL) score ≥10. TSI was graded as 1, 2, and 3 in 214 (45%), 151 (32%), and 109 (23%) patients, respectively. Higher TSI was significantly associated with a larger tumour size and a higher RENAL score. Overall, pT3a upstaging and Fuhrman grade 3–4 were observed in 45 (9.5%) and 116 patients (31% in 380 clear cell RCC cases), respectively. The incidence of pT3a upstaging and Fuhrman grade 3–4 was significantly higher in patients with higher TSI (0.5%, 8.6%, and 28% for pT3a upstaging and 12%, 33%, and 60% for Fuhrman grade 3–4 in TSI 1, 2, and 3 groups, respectively). In multivariable analyses, higher TSI was independently associated with adverse pathological outcomes. During the median follow-up of 6.0 yr, 49 patients (10%) developed recurrence. Multivariable analyses demonstrated that older age and higher TSI were independent risk factors for worse RFS. The limitations include the retrospective design. Conclusions: TSI may be a useful adjunct in preoperative risk stratification for adverse pathology and recurrence after surgery in clinically localised RCC. Patient summary: Tumour shape irregularity is significantly associated with unfavourable pathological outcomes, that is, locally advanced stage or high-grade cancer, and with a higher recurrence rate after surgery in patients with clinically localised renal cell carcinoma. Preoperative evaluation of the tumour shape may help in patient counselling and treatment decisions.http://www.sciencedirect.com/science/article/pii/S266616832202715XAdverse pathologyNephrectomyRecurrence-free survivalRenal cell carcinomaTumour shape irregularity |
| spellingShingle | Hajime Tanaka Shohei Fukuda Koichiro Kimura Yuki Fukawa Kouhei Yamamoto Hiroshi Fukushima Shingo Moriyama Yosuke Yasuda Sho Uehara Yuma Waseda Soichiro Yoshida Minato Yokoyama Yoh Matsuoka Kazutaka Saito Ukihide Tateishi Steven C. Campbell Yasuhisa Fujii Defining Tumour Shape Irregularity for Preoperative Risk Stratification of Clinically Localised Renal Cell Carcinoma European Urology Open Science Adverse pathology Nephrectomy Recurrence-free survival Renal cell carcinoma Tumour shape irregularity |
| title | Defining Tumour Shape Irregularity for Preoperative Risk Stratification of Clinically Localised Renal Cell Carcinoma |
| title_full | Defining Tumour Shape Irregularity for Preoperative Risk Stratification of Clinically Localised Renal Cell Carcinoma |
| title_fullStr | Defining Tumour Shape Irregularity for Preoperative Risk Stratification of Clinically Localised Renal Cell Carcinoma |
| title_full_unstemmed | Defining Tumour Shape Irregularity for Preoperative Risk Stratification of Clinically Localised Renal Cell Carcinoma |
| title_short | Defining Tumour Shape Irregularity for Preoperative Risk Stratification of Clinically Localised Renal Cell Carcinoma |
| title_sort | defining tumour shape irregularity for preoperative risk stratification of clinically localised renal cell carcinoma |
| topic | Adverse pathology Nephrectomy Recurrence-free survival Renal cell carcinoma Tumour shape irregularity |
| url | http://www.sciencedirect.com/science/article/pii/S266616832202715X |
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