Preoperative Tumor Shape Irregularity Is Associated With Pathological Upstaging to pT3 in Clinical T1 Renal Cell Carcinoma Treated With Partial or Radical Nephrectomy
Although patients with early-stage kidney cancer often experience a favorable prognosis, there are remaining unmet needs for patients with high-risk disease and those who are at an increased risk of disease recurrence, underscoring the need for further advances in the adjuvant space and effective biomarkers to better personalize therapy, according to Neil Mendhiratta, MD, MS.
Objectives: We evaluate whether preoperative tumor shape irregularity (TSI) is associated with pathological upstaging to pT3 in clinical T1 renal cell carcinoma (RCC) after partial nephrectomy or radical nephrectomy. Methods: We retrospectively reviewed 435 patients with clinical T1 RCC that underwent partial nephrectomy or radical nephrectomy between April 2007 and December 2025. TSI was graded as 1, 2, or 3 on preoperative computed tomography by three urologists. Inter‑observer agreement was assessed using the complete agreement rate and overall kappa coefficient. Logistic regression analyses were performed to identify independent preoperative predictors of upstaging to pT3. Results: Complete agreement for TSI was observed in 315 cases (72.4%), and the overall kappa coefficient was 0.64. Upstaging to pT3 occurred in 44 patients (10.1%), including one patient with pT3b. The rate of upstaging significantly increased across TSI categories, from 2.3% in TSI 1 to 15.7% in TSI 2, and to 63.6% in TSI 3 (p<0.01). In multivariable analysis, higher TSI remained independently associated with upstaging, with ORs of 5.16 for TSI 2 and 32.30 for TSI 3 compared with TSI 1 (both p<0.01). Clinical T1b stage was also an independent predictor (OR 4.93, p<0.01). Conclusions: Preoperative TSI was independently associated with pathological upstaging to pT3 in clinical T1 RCC and may aid preoperative risk assessment when considering nephron‑sparing surgery.
Identifying preoperative imaging features that predict upstaging can inform surgical decision‑making and improve patient selection for nephron‑sparing versus radical nephrectomy.
Bizonyítékszint: Irányelv / elfogadott gyakorlat. Magas szintű klinikai elfogadottság.
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