Abstract
BACKGROUND AND AIMS: A clear understanding of the risk of clear cell renal cell carcinoma (ccRCC) recurrence in individual patients is essential for appropriate administration of adjuvant therapy. Notably, non-metastatic pT3a ccRCCs are heterogeneous, and affected patients will have a different prognosis depending on the pathological definition. The present study was conducted to identify factors associated with postoperative recurrence in pT3a ccRCC cases. METHODS: We retrospectively reviewed 295 patients who underwent a radical or partial nephrectomy for RCC at our institution from 2013 to 2022 and identified 42 with pT3aN0M0 ccRCC. Preoperative clinical and pathological data, including blood parameters, were collected, and their association with recurrence-free survival (RFS) was evaluated. The Kaplan-Meier method and uni- and multivariable Cox proportional hazard regression were used for statistical analysis. RESULTS: Univariate and subsequent multivariate analyses showed white blood cells, platelets, and mixed patterns of pT3a components as independent prognostic factors with significant relationships with RFS. Kaplan-Meier curves revealed that the presence of leukocytosis or thrombocytosis was associated with worse RFS (p = 0.0002, p < 0.0001, respectively), while patients with a mixed pattern of pT3a components also had worse RFS as compared to those with a single pattern (p = 0.0007). Furthermore, accuracy for prediction of RFS in pT3a ccRCC cases was improved by classification based on the number of retained factors, that is, leukocytosis, thrombocytosis, and mixed patterns of pT3a components. CONCLUSIONS: The present findings indicate that inflammatory markers, such as leukocytes and platelets, as well as multiple patterns of extrarenal extension are factors useful for predicting RFS in patients with pT3aN0M0 ccRCC. Their combined use should aid in the selection of appropriate postoperative adjuvant therapy.