Proposed tripartite classification of T1 renal cell carcinoma: Comparison with current binary system.

IF 2.3 3区医学 Q3 ONCOLOGY

Urologic Oncology-seminars and Original Investigations Pub Date : 2025-09-02 DOI:10.1016/j.urolonc.2025.07.030

Margaret F Meagher, Giacomo Musso, Viraj Master, Hajime Tanaka, Umberto Capitanio, Allesandro Larcher, Mai Dabbas, Dattatraya Patil, Wei Chen, Dhruv Puri, Benjamin H Baker, Shamsunnahar Imtiaz, Cesare Saitta, Shohei Fukuda, Masaki Kobayashi, Andrea Salonia, Alberto Briganti, Yasuhisa Fujii, Francesco Montorsi, Ithaar H Derweesh

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引用次数: 0

Abstract

Objective: Outcomes of stage 1 renal cell carcinoma (RCC) are heterogeneous and vary widely. We sought to investigate whether tripartite reclassification of current binary T1 RCC would lead to more rational consolidation of similar outcomes that may improve predictive ability.

Methods: We performed a retrospective multicenter analysis of patients undergoing radical (RN) or partial nephrectomy (PN) for clinical T1N0M0 RCC. The cohort was divided into tumor size ≤3 cm, >3 cm or ≤5 cm, and >5 cm or ≤7 cm. Primary outcome was cancer-specific mortality/cancer-specific survival (CSM/CSS). Secondary outcomes were all-cause mortality/overall survival (ACM/OS) and recurrence/recurrence-free survival (recurrence/RFS). Multivariable analysis (MVA) was used to elucidate predictive factors for CSM, ACM, and recurrence. Kaplan-Meier Analysis (KMA) analyzed 10-year CSS, OS, and RFS. AUC/ROC analysis compared predictive capability of proposed tripartite reclassification of T1 defined as proposed-T1a (≤3 cm), T1b (>3 and ≤5 cm), and pT1c (>5 and ≤7 cm) vs. current binary T1a (≤4 cm) and T1b (>4 and ≤7 cm).

Results: 2,989 patients were analyzed (median follow-up 60 months). Increasing age (HR = 1.05, P < 0.001), proposed-T1c (vs. proposed-T1a referent [HR = 2.15, P = 0.008]), radical nephrectomy (HR 1.65, P = 0.023), and high-grade (HR = 2.44, P < 0.001) were associated with worsened CSM. Comparing proposed-T1a, T1b, and T1c, KMA revealed significantly worsened: 10-year OS with larger tumor size: (81% vs. 80% vs. 63%, respectively, P < 0.001) and 10-year CSS with larger tumor size (93% vs. 91% vs. 81%, respectively, P < 0.001). AUC analysis revealed greater predictive power for proposed-T1a, T1b, and T1c vs. current T1-RCC binary classification for OS (0.567 vs. 0.556) and CSS (0.643 vs. 0.599).

Conclusion: Proposed-Tripartite subclassification of T1 RCC into T1a, T1b, and T1c groups corresponds to distinctive populations whose biological potential aligns more closely and may enhance risk stratification, refine pretreatment counseling and postoperative follow-up compared to protocols based on current binary T1 classification.

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提出的T1肾细胞癌三段式分类：与目前二元分类的比较。

目的：1期肾细胞癌（RCC）的预后是异质性的，差异很大。我们试图研究当前二元T1 RCC的三方重新分类是否会导致更合理的类似结果巩固，从而提高预测能力。方法：我们对接受根治性（RN）或部分肾切除术（PN）治疗临床T1N0M0肾细胞癌的患者进行了回顾性多中心分析。分组分为肿瘤大小≤3cm、>≤3cm、>≤5cm、>≤7cm。主要终点是癌症特异性死亡率/癌症特异性生存率（CSM/CSS）。次要结局是全因死亡率/总生存期（ACM/OS）和复发/无复发生存期（复发/RFS）。多变量分析（MVA）用于阐明CSM、ACM和复发的预测因素。Kaplan-Meier分析（KMA）分析了10年的CSS、OS和RFS。AUC/ROC分析比较了提议的T1三重重分类的预测能力，定义为提议的T1a(≤3cm), T1b（>3和≤5cm）和pT1c（>5和≤7cm）与目前的二元T1a（≤4cm）和T1b（>4和≤7cm）。结果：共分析2989例患者（中位随访60个月）。年龄增加（HR = 1.05, P < 0.001）、建议t1c（相对于建议t1a参考[HR = 2.15, P = 0.008]）、根治性肾切除术（HR 1.65, P = 0.023）和高级别肾切除术（HR = 2.44, P < 0.001）与CSM恶化相关。比较建议的t1a、T1b和T1c， KMA显示明显恶化：肿瘤大小较大的10年OS（分别为81%、80%、63%，P < 0.001）和肿瘤大小较大的10年CSS（分别为93%、91%、81%，P < 0.001）。AUC分析显示，与目前的T1-RCC二元分类相比，拟议的t1a、T1b和T1c对OS （0.567 vs 0.556）和CSS （0.643 vs 0.599）的预测能力更强。结论：建议将T1型RCC分为T1a、T1b和T1c组，与目前基于T1二元分类的方案相比，这些人群的生物学潜力更接近，可以加强风险分层，改进预处理咨询和术后随访。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urologic Oncology-seminars and Original Investigations 医学-泌尿学与肾脏学

CiteScore

4.80

自引率

3.70%

发文量

297

审稿时长

7.6 weeks

期刊介绍： Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.