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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (4): 659-664. doi: 10.19723/j.issn.1671-167X.2021.04.006

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Risk factors of renal sinus invasion in clinical T1 renal cell carcinoma patients undergoing nephrectomy

SUN Zheng-hui,HUANG Xiao-juan,DONG Jing-han,LIU Zhuo,YAN Ye,LIU Cheng,MA Lu-lin()   

  1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-03-22 Online:2021-08-18 Published:2021-08-25
  • Contact: Lu-lin MA E-mail:malulin@medmail.com.cn

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Abstract:

Objective: To summarize the clinicoradiological characteristics of clinical T1 renal cell carcinoma patients and to investigate the risk factors of renal sinus invasion in cT1 renal cell carcinoma patients undergoing nephrectomy. Methods: A retrospective study was conducted in cT1 renal cell carcinoma patients from January 2016 to August 2019 in Department of Urology, Peking University Third Hospital, who underwent partial or radical nephrectomy by analyzing clinicopathological and radiological data. The influencing factors of renal sinus invasion for cT1 renal cell carcinoma were determined by χ2 test, Mann-Whitney U test and Logistic regression analysis. Results: A total of 507 patients were enrolled, including 354 males (69.8%) and 153 females (30.2%). The median age was 59 years and the median body mass index (BMI) was 25.5 kg/m2. Eighteen patients (3.6%) had gross hematuria preoperatively. The median tumor diameter was 3.5 cm. Three hundred twenty-two patients (63.5%) were staged clinical T1a and 165 cases (36.5%) were staged clinical T1b. The median R.E.N.A.L. score was 8. Three hundred fifty-nine patients (70.8%) had regular tumor border and 148 (29.2%) irregular. All the patients underwent surgical treatment, including 186 (36.7%) partial nephrectomy and 321 (63.3%) radical nephrectomy. Postoperative pathology showed seventy-five patients (14.8%) had renal sinus invasion, including 18 in cT1a (5.6%) and 57 in cT1b (30.8%). Univariate analysis showed that age (P=0.020), R.E.N.A.L. score (R value, E value, N value, P<0.001) and tumor border (P<0.001) were associated risk factors for cT1 renal cell carcinoma with renal sinus invasion. On multivariate binary Logistic analysis, R.E.N.A.L. score (P≤0.020) and irregular tumor border (P=0.001) were independent risk factors. Conclusion: For cT1 renal cell carcinoma patients undergoing nephrectomy, about 15% had renal sinus invasion postoperatively. High R.E.N.A.L. score and irre-gular tumor border help predicting cT1 renal cell carcinoma renal sinus invasion.

Key words: Renal cell carcinoma, Neoplasm invasiveness, Renal sinus, Neoplasm staging, Risk factors

CLC Number: 

  • R737.11

Figure 1

Example of tumor border definition A: This tumor in the right kidney had a clear border without tangent lines across tumor, which was defined as regular border. Pathological reports revealed a clear cell carcinoma without renal sinus invasion. B: This tumor in the left kidney had a clear border with lobulation, which was defined as re-gular border. Pathological reports confirmed tumor invasion into the renal sinus. C: This tumor in the right kidney had an unclear border whose tangent lines were hard to determine, which was defined as irregular border. Pathological reports confirmed clear cell carcinoma with macro tumor invasion into the renal sinus."

Table 1

Baseline clinical, pathological and radiological information of the patients"

Variables Total (n=507) cT1a (n=322) cT1b (n=185) Z/χ2 P
Age/years, M (P25,P75) 59.0 (48.0, 65.0) 56.5 (47.0, 64.3) 60.0(51-66) -2.206 0.027
Gender, n(%) 0.001 0.972
Male 354 (69.8) 225 (69.9) 129 (69.7)
Female 153 (30.2) 97 (30.1) 56 (30.3)
BMI/(kg/m2), M (P25, P75) 25.5(23.2, 27.9) 25.1(22.8, 27.9) 26.0(24.1-27.9) -2.033 0.042
Complains, n(%) 1.399 0.237
Hematuria 18 (3.6) 9 (2.8) 9 (4.9)
Non-hematuria 482 (96.4) 309 (97.2) 175 (95.1)
Tumor side, n(%) 0.001 0.981
Right 247 (48.7) 157 (48.8) 90 (48.6)
Left 260 (51.3) 165 (51.2) 95 (51.4)
Tumor size/cm, M (P25, P75) 3.5 (2.5, 4.6) 2.7 (2.1, 3.4) 5.0(4.4-5.9) -18.761 <0.001
R.E.N.A.L. score, M (P25,P75) 8 (6, 9) 6 (5, 8) 9 (8-10) 169.419 <0.001
Border, n(%) -2.483 0.013
Regular 359 (70.8) 272 (84.5) 87 (47.0)
Irregular 148 (29.2) 50 (15.5) 98 (53.0)
LN enlargement,n(%) 1.008 0.315
No 488 (96.3) 312 (96.9) 176 (95.1)
Yes 19 (3.7) 10 (3.1) 9 (4.9)
Surgical strategy, n(%) 185.390 <0.001
RN 186 (36.7) 47 (14.6) 139 (75.1)
PN 321 (63.3) 275 (85.4) 46 (24.9)
Histology, n(%) 4.735 0.860
Clear cell 431 (85.0) 275 (85.4) 156 (84.3)
Papillary 22 (4.3) 11 (3.4) 11 (6.0)
Chromophobe 21 (4.1) 13 (4.0) 8 (4.3)
Others 33 (6.5) 23 (7.1) 10 (5.4)
WHO/ISUP grade, n(%) 6.106 0.013
Ⅰ-Ⅱ 393 (84.1) 256 (87.4) 137 (78.7)
Ⅲ-Ⅳ 74 (15.8) 37 (12.6) 37 (21.3)
RSI, n(%) 59.293 <0.001
Yes 75 (14.8) 18 (5.6) 57 (30.8)
No 432 (85.2) 304 (94.4) 128 (69.2)
PFI, n(%) 6.058 0.014
Yes 19 (3.7) 7 (2.2) 12 (6.5)
No 488 (96.3) 315 (97.8) 173 (93.5)

Table 2

Comparison between RSI group and NRSI group (N=1 excluded)"

Variables NRSI (n=229) RSI (n=75) Z/χ2 P
Age/ years, M (P25, P75) 59.0 (47.0, 65.0) 63.0 (55.0, 66.0) -2.325 0.020
BMI/(kg/m2), M (P25, P75) 25.7 (23.4, 27.8) 24.9 (22.7, 27.5) -1.108 0.268
Complains, n(%) 0.264 0.853
Hematuria 9 (3.9) 4 (5.3)
Non-hematuria 219 (96.1) 71 (94.7)
Tumor size/cm, M (P25, P75) 4.0 (3.2, 5.1) 4.8 (4.1, 5.7) -3.782 <0.001
R.E.N.A.L. score, M (P25, P75) 9 (8, 9) 9 (9, 10) 27.509 <0.001
R value, n(%) 16.285 <0.001
1 116 (50.7) 18 (24.0)
2 113 (49.3) 57 (76.0)
E value, n(%) 7.908 0.019
1 82 (35.8) 14 (18.7)
2 94 (41.0) 41 (54.7)
3 53 (23.1) 20 (26.7)
N value, n(%) 20.335 <0.001
2 67 (29.3) 3 (4.0)
3 162 (70.7) 72 (96.0)
A, n(%) 0.042 0.853
Ventricle 110 (48.0) 35 (46.7)
Dorsal 119 (52.0) 40 (53.3)
L value, n(%) 0.408 0.815
1 33 (14.0) 9 (12.0)
2 78 (34.1) 24 (32.0)
3 119 (52.0) 42 (56.0)
Border, n(%) 20.867 <0.001
Regular 151 (65.9) 27 (36.0)
Irregular 78 (34.1) 48 (64.0)
LN enlargement, n(%) 0.034 1.000
No 218 (95.2) 71 (94.7)
Yes 11 (4.8) 4 (5.3)
Histology, n(%) 7.950 0.931
Clear cell 195 (85.2) 65 (86.7)
Non-clear cell 34 (14.8) 10 (13.3)
WHO/ISUP grade, n(%) 0.275 0.600
Ⅰ-Ⅱ 168 (80.0) 58 (81.7)
Ⅲ-Ⅳ 42 (18.3) 12 (16.9)

Table 3

Binary Logistic regression analysis of associated factors of cT1 renal cell carcinoma with renal sinus invasion"

Items OR (95%CI) P value
Age 1.02 (1.00-1.05) 0.062
R value 2.34 (1.15-4.78) 0.020
E value 2.19 (1.39-3.44) 0.001
N value 5.48 (1.59-18.91) 0.007
Border 2.72 (1.47-5.05) 0.001
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