Urinary collecting system invasion is associated with poor survival in patients with clear-cell renal cell carcinoma.

Objectives To evaluate the prognostic significance of urinary collecting system invasion in a large series of clear cell renal cell carcinoma patients. Materials Patients with clear cell renal cell carcinoma treated with nephrectomy between 2001 and 2010 were reviewed from a prospectively maintained registry. One urologic pathologist re-reviewed all slides. Cancer-specific survival was estimated using the Kaplan-Meier method and associations of collecting system invasion with death from renal cell carcinoma were evaluated using Cox models. Results Of the 859 patients with clear cell renal cell carcinoma, 58 (6.8%) demonstrated collecting system invasion. At last follow-up, 310 patients had died from renal cell carcinoma at a median of 1.8 years following surgery. Median follow-up for patients alive at last follow-up was 8.2 years. Estimated cancer-specific survival at 10 years following surgery for patients with collecting system invasion was 17%, compared with 60% for patients without collecting system invasion (p<0.001). In a multivariable model, collecting system invasion remained independently associated with an increased risk of death from renal cell carcinoma (hazard ratio 1.5, p=0.018). Further, among patients with pT3 renal cell carcinoma, those with collecting system invasion had survival outcomes similar to pT4 patients. Conclusions Collecting system invasion is associated with poor prognosis among patients with clear cell renal cell carcinoma. If validated, consideration should be given to including collecting system invasion in future staging systems. This article is protected by copyright. All rights reserved.