Outcomes and predictors of clinical T1 to pathological T3a tumor up-staging after robotic partial nephrectomy: A multi-institutional analysis

Michael A. Gorin, Mark W. Ball, Phillip M. Pierorazio, Youssef S. Tanagho, Sam B. Bhayani, Jihad H. Kaouk, Craig G. Rogers, Michael D. Stifelman, Ali Khalifeh, Ramesh Kumar, Ganesh Sivarajan, Mohamad E. Allaf

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


Purpose: We evaluated the early oncological end point of recurrence-free survival in patients with renal cell carcinoma up-staged from cT1 to pT3a after partial nephrectomy. We also aimed to establish preoperative factors associated with pathological tumor up-staging. Materials and Methods: A prospective database of robotic partial nephrectomy cases performed at 5 academic centers was queried for patients who underwent surgery for a solitary cT1 renal mass. Patients with pT1-2 renal cell carcinoma were compared to those with pT3a tumors to determine the difference in recurrence-free survival. Preoperative factors associated with cT1 to pT3a up-staging were studied using multivariate logistic regression analysis. Results: A total of 1,096 patients underwent robotic partial nephrectomy for a cT1 renal mass. At final pathological evaluation 855 tumors (78.0%) were found to be renal cell carcinoma, of which 41 (4.8%) were up-staged to pT3a. The 24-month recurrence-free survival estimates for pT1-2 and pT3a tumors were 99.2% and 91.8%, respectively (p = 0.003). Multivariate analysis revealed that a high vs low R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior and location relative to polar lines) nephrometry score was associated with tumor up-staging (OR 2.97, 95% CI 1.20-7.35, p = 0.02). On separate multivariate analysis increasing tumor diameter (OR 1.66, 95% CI 1.32-2.08, p <0.001) and hilar location (OR 2.83, 95% CI 1.43-5.61, p = 0.003) were also associated with up-staging. Conclusions: At short-term followup patients with renal cell carcinoma upstaged from cT1 to pT3a have reasonable oncological outcomes after partial nephrectomy. Factors associated with tumor up-staging include high tumor complexity, increasing tumor diameter and hilar location. Further studies are needed to determine the comparative efficacy of partial vs radical nephrectomy for small pT3a tumors.

Original languageEnglish (US)
Pages (from-to)1907-1911
Number of pages5
JournalJournal of Urology
Issue number5
StatePublished - Nov 2013


  • Carcinoma, renal cell
  • Kidney
  • Neoplasm staging
  • Nephrectomy
  • Robotics

ASJC Scopus subject areas

  • Urology


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