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Artículo Tomo 71, Número. 5, Junio 2018

Archivos Españoles de Urología

Kidney cancer stage pT3a: Fat invasion versus renal vein invasion.

Authors: Alfredo Aguilera Bazán, José María Alonso Dorrego, Estefanía Linares, Jesús Díez, Luis Miguel Quintana y Luis Martínez Piñeiro.

Arch. Esp. Urol. 2018; 71 (5): 474-479

Vol. 71, Number. 5, June 2018

OBJECTIVE: We discuss the influence that involvement of fat (perirenal, sinus) and vascular structures (renal vein, segmental veins) have on cancer-specific mortality (CSM) rates in renal cancer. METHODS: We conducted a retrospective analysis of 140 stage pT3a kidney tumors (114 clear cell, 9 type I papillary, 6 type II papillary, 11 chromophobe) surgically treated between 1997 and 2015. We conducted a cancer-specific survival study (Kaplan Meier) and a univariate and multivariate analysis of the variables: perirenal fat invasion, sinus fat invasion, renal vein invasion, segmental vein invasion and Fuhrman grade. RESULTS: With a mean follow-up of 79 months, 47 deaths occurred overall (31.7%), 29 of which were due to the kidney tumor (CSM 20%). There were 50 cases of vascular invasion (35.7%), 40 cases with fat only invasion (28.6%) and 50 cases with invasion of both (35.7%). In the survival study, fat invasion had the least impact (17%), and invasion of both (fat and vascular structures) had the worst survival (48% of total mortality). Vascular invasion represents 35% of the mortality rate. In the multivariate study, Fuhrman grade 3–4 (HR 10.7), renal vein invasion (HR 9.2) and concomitant vascular and fat invasion (HR 5.6) are the factors with the greatest impact. CONCLUSIONS: Tumor fat invasion has a lower impact on the CSM of kidney cancer than vascular invasion.

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