Pathological Stage T3a Significantly Increases Disease Recurrence across All Tumor Sizes in Renal Cell Carcinoma

Michael Chevinsky, Mariam Imnadze, Alexander Sankin, Andrew Winer, Roy Mano, Christopher Jakubowski, Joseph Mashni, Daniel D. Sjoberg, Ying Bei Chen, Satish K. Tickoo, Victor E. Reuter, A. Ari Hakimi, Paul Russo

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Purpose Tumor size and stage are important prognostic parameters in renal cell carcinoma. While pathological stage T1 and T2 are defined by size alone, the presence of certain intrinsic features can up stage a tumor to pathological stage T3a regardless of size. We investigate the effect of pathological tumor stage on the relationship between tumor size and risk of disease recurrence. Materials and Methods Data were reviewed on patients who underwent nephrectomy at our institution between 2006 and 2013 to identify all those with pathological stage T1, T2 and T3a tumors. A proportional hazards Cox model was built with time to recurrence as outcome, and pathological stage and tumor size as covariates. An interaction term for stage and tumor size was included. Results The final cohort included 1,809 patients. On multivariable analysis, when adjusted for tumor size, patients with pT3a tumors had a greater risk of tumor recurrence compared to those with pT1/T2 tumors (HR 3.70; 95% CI 2.31, 5.92; p <0.0001). The risk of disease recurrence increased more rapidly as tumor size increased only with the presence of perinephric fat invasion (p=0.006). Conclusions Using the AJCC 2010 staging criteria we validated pathological stage T3a as a poor prognostic factor in renal cell carcinoma regardless of tumor size. Our results also demonstrated an increased rate of risk of recurrence with perinephric fat invasion. Given this increased risk of recurrence, even in tumors less than 4 cm, closer surveillance is warranted in such cases and the role of perinephric involvement necessitates further investigation.

Original languageEnglish (US)
Pages (from-to)310-315
Number of pages6
JournalJournal of Urology
Issue number2
StatePublished - 2015
Externally publishedYes


  • carcinoma
  • neoplasm staging
  • recurrence
  • renal cell

ASJC Scopus subject areas

  • Urology


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