Is Renal Capsular Invasion, Without Perinephric Fat Invasion, A Marker Of Aggressive Biology In Renal Cell Carcinoma?

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 07 Aug 2006 - 0:00 PDT

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UroToday.com - Perinephric fat invasion is an accepted pathologic marker of aggressive biology in renal cell carcinoma (RCC). Renal capsule invasion, without perinephric fat invasion, is often reported in pathology reports but is not accounted for in current TNM staging as a distinct classification that differentiates outcome. In this study by Jeong and colleagues, renal capsule invasion in otherwise organ confined RCC is examined as a marker of virulence in RCC.

Over an 11 year period, 288 patients with conventional (clear cell) RCC with T1-2N0M0 were evaluated for evidence of renal capsular invasion. Mean follow-up was 61 months (range 20-145 months). Renal capsule invasion was present in 108 patients (37.5%). In T1 patients, 33.9% had capsular invasion, whereas 57.7% of T2 patients had capsular invasion. Capsular invasion was associated with a worse T stage (p=0.015). In examining the entire study group, no difference was noted in disease specific survival (DSS) based on the presence or absence of capsular invasion (p=0.132). In subset analysis, there was no prognostic significance of capsular invasion for T1 tumors, but capsular invasion was associated with a worse prognosis in T2 tumors (p=0.031), after controlling for grade, age, and tumor size. The 5 year DSS was 90.5% for patients without capsular invasion and 73.8% for patients with capsular invasion in the T2 stage group. There was a correlation between tumor size and the presence of capsular invasion in T1 tumors (p=0.021) but not T2 (p=0.841) tumors.

Renal capsule invasion may be a marker of aggressive biology in RCC, reflecting a tumor with invasive, and perhaps metastatic, potential. Further study is needed to identify the frequency with which this phenomenon is found in localized renal cell carcinoma to truly assess whether or not its presence warrants stratification in RCC staging systems.

By Christopher G. Wood, M.D.

Reference:
Jeong IG, et al., Urology 67(4): 709-712, 2006.
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