Objectives: To evaluate prognostic factors in pT1b renal cell carcinoma (RCC) patients for which no specific studies have been conducted on. Methods: The data of 270 patients diagnosed with pT1bN0M0 RCC at 2 institutions between January 1998 and June 2010 were retrospectively analyzed. Univariate and multivariate analyses using Cox proportional hazard models were used to identify pathologic and clinical factors that influenced prognosis. Five-year recurrence-free survival and cancer-specific survival were analyzed using the Kaplan-Meier method. Results: The median follow-up period was 55.5 months, and the mean patient age was 55.2 years (range: 26-80). There were 12 cancer-related deaths, and tumor recurrence was noted in 22 patients between 8 and 120 months after surgery. Sites of metastases included the lung in 13 patients, bone in 5 patients, and other sites in 4 patients. Five-year recurrence-free survival and cancer-specific survival rates were 91.2 and 93.5%, respectively. Multivariate analyses revealed that the presence of microvascular invasion and tumor necrosis independently predicted prognosis. Conclusions: Microvascular invasion and tumor necrosis were found to be independent prognostic factors in pT1b RCC. This result will help urologists to provide patients with more accurate prognoses, and patients with confirmed microvascular invasion and tumor necrosis will require closer follow-up.

Luciani LG, Cestari R, Tallarigo C: Incidental renal cell carcinoma-age and stage characterization and clinical implications: study of 1092 patients (1982-1997). Urology 2000;56:58-62.
Psutka SP, Feldman AS, McDougal WS, McGovern FJ, Mueller P, Gervais DA: Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol 2013;63:486-492.
Lau WK, Cheville JC, Blute ML, Weaver AL, Zincke H: Prognostic features of pathologic stage T1 renal cell carcinoma after radical nephrectomy. Urology 2002;59:532-537.
Zini L, Patard JJ, Capitanio U, Crepel M, de La Taille A, Tostain J, et al: Cancer-specific and non-cancer-related mortality rates in European patients with T1a and T1b renal cell carcinoma. BJU Int 2009;103:894-898.
Kim HL, Han KR, Zisman A, Figlin RA, Belldegrun AS: Cachexia-like symptoms predict a worse prognosis in localized T1 renal cell carcinoma. J Urol 2004;171:1810-1813.
Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H: Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003;170:2217-2220.
Goncalves PD, Srougi M, Dall'lio MF, Leite KR, Ortiz V, Hering F: Low clinical stage renal cell carcinoma: relevance of microvascular tumor invasion as a prognostic parameter. J Urol 2004;172:470-474.
Ha YS, Park YH, Kang SH, Hong SH, Hwang TK, Byun SS, et al: Predictive factors for late recurrence in patients with stage T1 clear cell renal cell carcinoma: a multiinstitutional study. Clin Genitourin Cancer 2013;11:51-55.
Xiong ZQ, Zheng J, Feng CC, Bao Y, Ding Q, Fang ZJ: Low local metastatic rate may widen indication of nephron-sparing surgery for renal cell carcinoma. Ann Diagn Pathol 2012;16:190-195.
Zhang ZL, Chen W, Li YH, Liu ZW, Luo JH, Lau W, et al: Stage T1N0M0 renal cell carcinoma: the prognosis in Asian patients. Chin J Cancer 2011;30:772-778.
Patard JJ, Rodriguez A, Rioux-Leclercq N, Guille F, Lobel B: Prognostic significance of the mode of detection in renal tumours. BJU Int 2002;90:358-363.
Siegel R, Naishadham D, Jemal A: Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29.
Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, et al: Guideline for management of the clinical T1 renal mass. J Urol 2009;182:1271-1279.
Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, et al: EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010;58:398-406.
Zhang ZL, Li YH, Xiong YH, Hou GL, Yao K, Dong P, et al: Oncological outcome of surgical treatment in 336 patients with renal cell carcinoma. Chin J Cancer 2010;29:995-999.
Kim SP, Weight CJ, Leibovich BC, Thompson RH, Costello BA, Cheville JC, et al: Outcomes and clinicopathologic variables associated with late recurrence after nephrectomy for localized renal cell carcinoma. Urology 2011;78:1101-1106.
Miyao N, Naito S, Ozono S, Shinohara N, Masumori N, Igarashi T, et al: Late recurrence of renal cell carcinoma: retrospective and collaborative study of the Japanese Society of Renal Cancer. Urology 2011;77:379-384.
Lam JS, Shvarts O, Leppert JT, Figlin RA, Belldegrun AS: Renal cell carcinoma 2005: new frontiers in staging, prognostication and targeted molecular therapy. J Urol 2005;173:1853-1862.
Yasunaga Y, Shin M, Miki T, Okuyama A, Aozasa K: Prognostic factors of renal cell carcinoma: a multivariate analysis. J Surg Oncol 1998;68:11-18.
Samma S, Yoshida K, Ozono S, Ohara S, Hayashi Y, Tabata S, et al: Tumor thrombus and microvascular invasion as prognostic factors in renal cell carcinoma. Jpn J Clin Oncol 1991;21:340-345.
Sevinc M, Kirkali Z, Yorukoglu K, Mungan U, Sade M: Prognostic significance of microvascular invasion in localized renal cell carcinoma. Eur Urol 2000;38:728-733.
Van Poppel H, Vandendriessche H, Boel K, Mertens V, Goethuys H, Haustermans K, et al: Microscopic vascular invasion is the most relevant prognosticator after radical nephrectomy for clinically nonmetastatic renal cell carcinoma. J Urol 1997;158:45-49.
Dall'Oglio MF, Ribeiro-Filho LA, Antunes AA, Crippa A, Nesrallah L, Goncalves PD, et al: Microvascular tumor invasion, tumor size and Fuhrman grade: a pathological triad for prognostic evaluation of renal cell carcinoma. J Urol 2007;178:425-428, discussion 428.
Lang H, Lindner V, Letourneux H, Martin M, Saussine C, Jacqmin D: Prognostic value of microscopic venous invasion in renal cell carcinoma: long-term follow-up. Eur Urol 2004;46:331-335.
Ishimura T, Sakai I, Hara I, Eto H, Miyake H: Microscopic venous invasion in renal cell carcinoma as a predictor of recurrence after radical surgery. Int J Urol 2004;11:264-268.
Lam JS, Shvarts O, Said JW, Pantuck AJ, Seligson DB, Aldridge ME, et al: Clinicopathologic and molecular correlations of necrosis in the primary tumor of patients with renal cell carcinoma. Cancer 2005;103:2517-2525.
Leibovitch I, Lev R, Mor Y, Golomb J, Dotan ZA, Ramon J: Extensive necrosis in renal cell carcinoma specimens: potential clinical and prognostic implications. Isr Med Assoc J 2001;3:563-565.
Sabo E, Boltenko A, Sova Y, Stein A, Kleinhaus S, Resnick MB: Microscopic analysis and significance of vascular architectural complexity in renal cell carcinoma. Clin Cancer Res 2001;7:533-537.
Ficarra V, Righetti R, Martignoni G, D'Amico A, Pilloni S, Rubilotta E, et al: Prognostic value of renal cell carcinoma nuclear grading: multivariate analysis of 333 cases. Urol Int 2001;67:130-134.
Klatte T, Patard JJ, de Martino M, Bensalah K, Verhoest G, de la Taille A, et al: Tumor size does not predict risk of metastatic disease or prognosis of small renal cell carcinomas. J Urol 2008;179:1719-1726.
Minervini A, Lilas L, Minervini R, Selli C: Prognostic value of nuclear grading in patients with intracapsular (pT1-pT2) renal cell carcinoma. Long-term analysis in 213 patients. Cancer 2002;94:2590-2595.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.