Prognostic relevance of capsular involvement and collecting system invasion in stage I and II renal cell carcinoma
Article first published online: 22 JAN 2007
Volume 99, Issue 4, pages 821–824, April 2007
How to Cite
Klatte, T., Chung, J., Leppert, J. T., Lam, J. S., Pantuck, A. J., Figlin, R. A. and Belldegrun, A. S. (2007), Prognostic relevance of capsular involvement and collecting system invasion in stage I and II renal cell carcinoma. BJU International, 99: 821–824. doi: 10.1111/j.1464-410X.2006.06729.x
- Issue published online: 22 JAN 2007
- Article first published online: 22 JAN 2007
- Accepted for publication 27 October 2006
- collecting system;
- kidney cancer
To define the prognostic relevance of capsular involvement (invasion with no penetration) and collecting-system invasion in patients with stage I (pT1N0M0) and stage II (pT2N0M0) renal cell carcinoma (RCC), by evaluating the outcome of patients treated with nephrectomy.
PATIENTS AND METHODS
In all, 519 patients from a kidney cancer database treated with nephrectomy for stage I and II RCC between 1985 and 2005 were assessed retrospectively. The primary endpoint was recurrence-free survival time. The prognostic relevance of capsular involvement and collecting-system invasion were examined using univariate and multivariate survival analysis.
Capsular involvement and collecting-system invasion were evident in 112 (21.6%) and 39 (7.5%) patients, respectively. Capsular involvement was associated with higher Fuhrman grades and larger tumours. The incidence of collecting-system invasion was higher in patients with microvascular invasion. The median follow-up was 49 months. In univariate analysis, patients with capsular involvement and collecting-system invasion had a worse prognosis than patients without (P = 0.007 and <0.001, respectively). In multivariate analysis, capsular involvement (hazard ratio 1.84, P = 0.036) and collecting-system invasion (3.78, P < 0.001) were independent prognostic factors of recurrence-free survival. Interestingly, there was no survival difference between patients with capsular involvement in stage I/II and patients with invasion of perinephric tissue (pT3aN0M0).
These findings suggest that capsular involvement and collecting-system invasion are poor prognostic findings in stage I and II RCC. They should both be considered when planning the follow-up. A revised pT3a stage including patients with capsular involvement could improve its prognostic validity.