To stage or not to stage: determining the true clinical significance of the biopsy tract through perinephric fat in assessing renal cell carcinoma

Aida Valencia-Guerrero, Esther Oliva, Chin Lee Wu, Shulin Wu, Travis Rice-Stitt, Peter M. Sadow, Douglas M. Dahl, Adam S. Feldman, Ronald S. Arellano, Kristine M. Cornejo

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Perinephric fat invasion (PFI) is a key component of renal cell carcinoma (RCC) staging, but there are limited data pertaining to biopsy tract seeding (BTS) resulting in perirenal tissue involvement [BTS with perinephric fat invasion (BTS-P)].The aim is to correlate clinical outcomes with pathologic stage to determine whether the presence of BTS-P should be considered a criterion to stage RCC as part of the pT3a category in the absence of any other upstaging variables. Materials and results: We identified 304 renal biopsies from patients with subsequent nephrectomies for RCC; 33 of the tumours contained PFI. Each case was reviewed to determine the presence of BTS-P and other forms of invasion [e.g. non-BTS-P PFI, sinus fat invasion (SFI), and/or renal vein invasion (RVI)], and these findings were compared with survival outcomes. Ten (30%) of 33 tumours with PFI showed BTS-P as the only finding, and were otherwise pT1 tumours; six (60%) patients were alive without disease (AWOD) (mean, 77.5 months), three were lost to follow-up (LTF), and one died of other disease (DOOD). Two patients showed true PFI plus BTS-P; one was LTF and one is AWOD at 107 months. Ten (43%) of 23 patients with tumours with true invasion (PFI ± SFI and/or RVI) are AWOD (mean, 97.7 months), eight (35%) died of disease (DOD), four were LTF, and one DOOD. Kaplan–Meier survival curves showed that the cancer-specific survival was significantly worse in patients with true invasion (P = 0.044) than in those with BTS-P as the sole finding. Conclusion: Patients with tumours showing BTS-P only appear to have better outcomes than those with other non-PFI invasion, suggesting that this finding should not be upstaged to pT3a. Additional studies are needed to corroborate the significance of our observations.

Original languageEnglish (US)
Pages (from-to)951-962
Number of pages12
JournalHistopathology
Volume78
Issue number7
DOIs
StatePublished - Jun 2021
Externally publishedYes

Keywords

  • biopsy tract seeding
  • perinephric fat invasion
  • renal cell carcinoma
  • staging
  • survival

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

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