Classification of Histologic Patterns of Pseudocapsular Invasion in Organ-Confined Renal Cell Carcinoma

Association between decreased ipsilateral renal function and aggressive behavior in renal cell carcinoma

Background

To assess prognostic value of pre-operative ipsilateral split renal function (SRF) on disease-free survival (DFS) and its association with aggressive pathological features in renal cell carcinoma (RCC) patients. 

Methods

We examined patients registered in SNUG-RCC-Nx who underwent partial or radical nephrectomy at Seoul National University Hospital between January 1, 2010 and December 31, 2020. Patients with the following criteria were excluded from the study. 1) non-kidney origin cancer or benign renal tumor, 2) no pre-operative Tc 99 m-DTPA renal scan, 3) single kidney status or previous partial or radical nephrectomy, and 4) bilateral renal mass. Finally, 1,078 patients were included.

Results

Among 1,078 patients, 899 (83.4%) showed maintained ipsilateral SRF on DTPA renal scan; 179 patients (16.6%) showed decreased SRF. The decreased SRF group showed significantly large tumor size (maintained vs. decreased SRF; 3.31 ± 2.15 vs. 6.85 ± 3.25, p < 0.001), high Fuhrman grade (grade 3–4) (41.7% vs. 55.6%, p < 0.001), and high T stage (T stage 3–4) (9.0% vs. 20.1%, p < 0.001). Pathological invasive features, including invasion of the renal capsule, perirenal fat, renal sinus fat, vein, and collecting duct system, were associated with low SRF of the ipsilateral kidney. Univariate Cox regression analysis identified higher SSIGN (The stage, size, grade, and necrosis) score and decreased ipsilateral SRF as significant risk factors, while multivariate analysis showed SSIGN (5–7) (hazard ratio [HR] 11.9, p < 0.001) and SSIGN (8–10) (HR 69.2, p < 0.001) were significantly associated with shortened DFS, while decreased ipsilateral SRF (HR 1.75, p = 0.065) showed borderline significance. Kaplan–Meier analysis showed that decreased ipsilateral SRF (< 45%) group had shorter DFS than the other group (median DFS: 90.3 months vs. not reached, p < 0.001).

Conclusions

Among unilateral RCC patients, those with low ipsilateral SRF showed poor prognosis with pathologically invasive features. Our novel approach may facilitate risk stratification in RCC patients, helping formulate a treatment strategy.

Dynamic Predictive Models with Visualized Machine Learning for Assessing the Risk of Lung Metastasis in Kidney Cancer Patients

Objective

To establish and verify the clinical prediction model of lung metastasis in renal cancer patients.

Method

Kidney cancer patients from January 1, 2010, to December 31, 2017, in the SEER database were enrolled in this study. In the first section, LASSO method was adopted to select variables. Independent influencing factors were identified after multivariate logistic regression analysis. In the second section, machine learning (ML) algorithms were implemented to establish models and 10-foldcross-validation was used to train the models. Finally, receiver operating characteristic curves, probability density functions, and clinical utility curve were applied to estimate model's performance. The final model was shown by a website calculator.

Result

Lung metastasis was confirmed in 7.43% (3171 out of 42650) of study population. In multivariate logistic regression, bone metastasis, brain metastasis, grade, liver metastasis, N stage, T stage, and tumor size were independent risk factors of lung metastasis in renal cancer patients. Primary site and sequence number were independent protection factors of LM in renal cancer patients. The above 9 impact factors were used to develop the prediction models, which included random forest (RF), naive Bayes classifier (NBC), decision tree (DT), xgboost (XGB), gradient boosting machine (GBM), and logistic regression (LR). In 10-foldcross-validation, the average area under curve (AUC) ranked from 0.907 to 0.934. In ROC curve analysis, AUC ranged from 0.879–0.922. We found that the XGB model performed best, and a Web-based calculator was done according to XGB model.

Conclusion

This study provided preliminary evidence that the ML algorithm can be used to predict lung metastases in patients with kidney cancer. This low cost, noninvasive and easy to implement diagnostic method is useful for clinical work. Of course this model still needs to undergo more real-world validation.

Prognostic significance of pseudocapsule status in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors

Background

We sought to determine whether pseudocapsule (PS) features have prognostic implications in patients with metastatic renal cell carcinoma (mRCC).

Methods

We retrospectively reviewed 231 patients diagnosed with mRCC and treated with tyrosine kinase inhibitors; 188 patients with data available regarding the tumor-parenchyma interfacial PS of the primary tumor were enrolled for analysis. PS status was evaluated as intact (grade 0), merely involved (grade 1), penetrated (grade 2), and absent (grade 3). We applied the Kaplan-Meier method and Cox regression model to assess the survival impact.

Results

Of the 188 patients, 19 (10.1%), 61 (32.4%), 96 (51.1%) and 12 (6.4%) had grade 0, 1, 2 and 3 PS, respectively. PS status was significantly associated with histology (P=0.0206), venous tumor embolus (P=0.0511), microvascular invasion (P=0.0108) and microsatellite formation (P=0.0097). Patients without a PS had the worst overall survival (OS), with a 3-year OS rate of 12.7%, whereas the OS rates for grades 0, 1 and 2 were 78.8%, 50.8% and 43.6%, respectively. Adjusted by other variables, grade 3 and grade 2 PS gave rise to a much higher risk of death across the cohort [hazard ratio (HR) =5.217, P=0.0182; HR =3.765, P=0.0281, respectively]. Sarcomatoid change was also an independent factor for OS (HR =2.932, P=0.0075). In contrast, microsatellite formation was not associated with survival in the cohort.

Conclusions

PS status has prognostic implications for OS in metastatic renal cancer. The absence of the PS and sarcomatoid change are two pathological features related to an extremely poor prognosis.

Histopathological validation of safe margin for nephron-sparing surgery based on individual tumor growth pattern

Background

To evaluate the clinicopathologic value of morphological growth patterns of small renal cell carcinoma (sRCC) and determine the actual demand for taking a rim of healthy parenchyma to avoid positive SM.

Methods

Data was collected from 560 sRCC patients who underwent laparoscopic surgeries from May 2010 to October 2017. One hundred forty-nine cases received nephron-sparing surgery (NSS) and others received radical nephrectomy (RN). All specimens were analyzed separately by two uropathologists, and three morphological growth patterns were identified. The presence of pseudocapsule (PC), surgical margins (SM), and other routine variables were recorded. The relationship between growth patterns and included variables was measured by the χ² test and Fisher’s exact probability test. Survival outcomes were evaluated by Kaplan-Meier method and the log-rank test.

Results

The median age of patients was 63.2 years old and the mean tumor diameter was 3.0 cm. Four hundred eighty (85.7%) cases were clear cell RCC and 541 (96.6%) cases were at the pT1a stage. Peritumoral PC was detected in 512 (92.5%) specimens, and the ratio of tumor invasion in PC in infiltration pattern increased obviously than that of the other growth patterns. Similarly, the pT stage was significantly correlated with the infiltration pattern as well. One hundred forty-nine patients underwent NSS and 3 (2.0%) of them showed positive SM after operation. Statistical differences of the 5-year overall survival (OS) and the cancer-specific survival (CSS) existed between different morphological growth patterns, PC status, and pT stages.

Conclusions

Morphological growth patterns of sRCC might be used as a potential biomarker to help operate NSS to avoid the risk of positive SM. How to distinguish different morphological growth patterns before operation and the effectiveness of the growth pattern as a novel proposed parameter to direct NSS in sRCC patients deserves further exploration.

Evaluation of the morphological features and unfavorable prognostic impact of dirty necrosis in renal cell carcinoma

PURPOSE

Tumor necrosis (TN) is one of the unfavorable prognostic factors in renal cell carcinoma (RCC). We identified two patterns of TN according to their morphology: dirty necrosis and ghost necrosis. We aimed to elucidate the morphological features and unfavorable prognostic impact of dirty necrosis in RCC.

METHODS

A total of 261 tumors collected after nephrectomy, which were pathologically identified as RCC, were analyzed in this study. We classified TN as dirty necrosis or ghost necrosis and compared their clinicopathological features. We also assessed their morphological features using digitally analyzed slides. The correlation between tumor size and necrosis area or the number of necrotic foci was calculated.

RESULTS

There were 77 tumors (30%) with TN, and the presence of TN was significantly associated with unfavorable clinicopathological factors. Thirty tumors (39%) had dirty necrosis, and 47 tumors (61%) had ghost necrosis. There were significantly higher numbers of unfavorable factors associated with dirty necrosis than with ghost necrosis. In dirty necrosis, both the TN area and the number of necrotic foci were correlated with tumor size (p < 0.001 and p = 0.003, respectively). However, in ghost necrosis, no correlation was found between tumor size and the number of necrotic foci (p = 0.58). Tumors (without stage IV) with dirty necrosis had a significantly shorter disease-free survival time than those with ghost necrosis and those without TN (p = 0.024 and p < 0.001, respectively).

CONCLUSION

Dirty necrosis has potential as an unfavorable prognostic indicator of surgically resected RCC.

Kidney cancer PDOXs reveal patient-specific pro-malignant effects of antiangiogenics and its molecular traits

An open debate in antiangiogenic therapies is about their consequence on tumor invasiveness and metastasis, which is undoubtedly relevant for patients currently treated with antiangiogenics, such as renal cell carcinoma patients. To address, this we developed an extensive series of 27 patient biopsy‐derived orthotopic xenograft models (Ren‐PDOX) that represent inter‐patient heterogeneity. In specific tumors, antiangiogenics produced increased invasiveness and metastatic dissemination, while in others aggressiveness remained unchanged. Mechanistically, species‐discriminative RNA sequencing identified a tumor cell‐specific differential expression profile associated with tumor progression and aggressivity in TCGA RCC patients. Gene filtering using an invasion‐annotated patient series pinpointed two candidate genes, of which ALDH1A3 differentiated the pro‐invasive subtype of Ren‐PDOXs. Validation in an independent series of 15 antiangiogenic‐treated patients confirmed that pre‐treatment ALDH1A3 can significantly discriminate patients with pro‐aggressive response upon treatment. Overall, results confirm that effects of antiangiogenic drugs on tumor invasion and metastasis are heterogeneous and may profoundly affect the natural progression of tumors and promote malignancy. Furthermore, we identify a specific molecular biomarker that could be used to select patients that better benefit from treatment.

Exploration of IMDC model in patients with metastatic renal cell carcinoma using targeted agents: a meta-analysis

Purpose:

To explore the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model application for predicting outcome of patients with metastatic renal cell carcinoma using targeted agents.

Materials and Methods:

We performed a literature review of 989 articles. The selecting process used preferred reporting items for systematic reviews and meta-analyses (PRISMA). All included studies were assessed by Newcastle-Ottawa scale. Results of individual studies were pooled using Stata 14.0 software.

Results:

A total of 17 articles were included. Most articles provided univariate and multivariate analysis of IMDC model prognosis. Combined HRs were 1.58 (95% CI 1.34-1.82) and 3.74 (95% CI 2.67-4.81) for univariate PFS of intermediate to favorable and poor to favorable respectively. In the category of multivariate PFS, combined HRs were 1.27 (95% CI 0.99-1.56) and 2.29 (95% CI 1.65-2.93) with intermediate to favorable and poor to favorable respectively. Regarding univariate OS, combined HRs were 1.93 (95% CI 1.62-2.24) and 6.25 (95% CI 4.18-8.31) with intermediate to favorable and poor to favorable respectively. With multivariate OS, combined HRs were 1.32 (95%CI 1.04-1.59) and 2.35 (95%CI 1.69-3.01) with intermediate to favorable and poor to favorable respectively.

Conclusion:

In summary, analysis of currently available clinical evidence indicated that IMDC model could be applied to classify patients with metastatic renal cell carcinoma using targeted agents. However, different types of targeted agents and various areas could affect the accuracy of the model. There was also a difference in predicting patients' PFS and OS.

Intracellular Chloride Ion Channel Protein-1 Expression in Clear Cell Renal Cell Carcinoma

BACKGROUND/AIM

Chloride intracellular channel 1 (CLIC1) represents a promising target for personalized therapy. Our aim was to assess CLIC1 expression in clear cell renal cell carcinoma (cc RCC) and identify its possible prognostic role.

MATERIALS AND METHODS

Fifty cases of cc RCC were evaluated and selected for immunohistochemistry. CLIC1 expression was correlated with tumor grade, invasion and heterogeneity.

RESULTS

A total of 87.5% of the cases were CLIC1 positive, with either a homogeneous (31.42%) or a heterogeneous (68.57%) pattern. Low, mild and strong CLIC1 expressing tumors were defined based on nuclear (N), cytoplasmic (C), membrane (M) or combinations of them (NC, NM, CM, NCM) in terms of CLIC1 distribution. A significant correlation was found between tumor grade and percent of positive tumor cells (p=0.017). For G3 tumors, CLIC1 cytoplasmic expression was strongly correlated with high expression status (p=0.025) and tumor heterogeneity (p=0.004). CLIC1 expression was also correlated with metastasis (p=0.046).

CONCLUSION

We defined four cc RCC groups depending on G, CLIC1 expression and pattern: i) G3/NM/low CLIC1⁺, ii) G2/CM/mild CLIC1⁺ iii) G1 or G2/NM or CM /high CLIC1⁺, and iv) G2/M /high CLIC1^.

Infiltrative Renal Masses: Clinical Significance and Fidelity of Documentation

BACKGROUND

The prevalence of infiltrative renal masses (IRMs) and fidelity of documentation of infiltrative features remain unclear.

OBJECTIVE

To investigate the prevalence/significance of IRMs and assess whether infiltrative features were documented preoperatively.

DESIGN, SETTING, AND PARTICIPANTS

A total of 522 patients with renal tumors managed with partial/radical nephrectomy (2012-2014) whose pathology demonstrated locally advanced and/or aggressive histology were analyzed. Preoperative computed tomography/magnetic resonance imaging was retrospectively/independently reviewed by two radiologists. IRMs were required to have a poorly defined interface with parenchyma and nonelliptical shape in one or more distinct/unequivocal areas. Infiltrative features were defined as extensive or focal.

INTERVENTION

Partial/radical nephrectomy.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Cancer-specific mortality (CSM) was estimated using cumulative-incidence analysis. Significant and independent predictors of CSM were evaluated using Cox proportional hazard analysis.

RESULTS AND LIMITATIONS

Median tumor size was 6.9cm; renal cell carcinomas (RCCs) predominated (92%). Image review confirmed 133 IRMs (25%), including 103 RCCs; 59 had sarcomatoid or poorly differentiated features. IRMs were larger and more often symptomatic compared than non-IRMs, and disseminated disease was also more common for IRMs (all p<0.001). Overall, 109 IRMs were imaged at our center; 42 were documented as IRMs in preoperative radiology reports, while infiltrative features were not documented in 67 (61%). Only four (6%) of these 67 were documented as infiltrative by the surgical team. Infiltrative features were more often focal in undocumented IRMs. On multivariable analysis, infiltrative features, disseminated disease, and non-RCC histology were independent predictors of CSM (hazard ratio or HR [95% confidence interval {CI}]=1.73 [1.21-2.47], 2.98 [2.10-4.23], and 2.79 [1.86-4.62], respectively). Among IRMs, extensive infiltrative features and disseminated disease were associated with CSM (HR [95% CI]=1.98 [1.27-3.07] and 2.35 [1.52-3.63], respectively), while documentation status failed to show an association. Excluding patients with disseminated disease or residual cancer after surgery, recurrence rates were 62% for IRMs versus 22% for non-IRMs (p<0.001), and there was again no significant difference between documented and undocumented IRMs (p=0.36). Limitations include a retrospective design.

CONCLUSIONS

Twenty-five percent of locally advanced/histologically aggressive renal tumors exhibited infiltrative features, although many were not documented as IRMs. Among this high-risk surgical population, infiltrative features were independent predictors of CSM, irrespective of whether they were documented or not. Our data suggest that infiltrative features should be assessed and documented routinely during evaluation of renal masses.

PATIENT SUMMARY

Infiltrative renal masses may be more common than previously appreciated, although many were not documented as infiltrative during preoperative evaluation. Our data suggest that infiltrative features have a strong impact on prognosis and should be assessed and documented routinely during radiologic and clinical evaluation of renal masses.

Accuracy of magnetic resonance imaging to identify pseudocapsule invasion in renal tumors

PURPOSE

To evaluate accuracy of MRI in detecting renal tumor pseudocapsule (PC) invasion and to propose a classification based on imaging of PC status in patients with renal cell carcinoma.

METHODS

From January 2017 to June 2018, 58 consecutive patients with localized renal cell carcinoma were prospectively enrolled. MRI was performed preoperatively and PC was classified, according to its features, as follows: MRI-Cap 0 (absence of PC), MRI-Cap 1 (presence of a clearly identifiable PC), MRI-Cap 2 (focally interrupted PC), and MRI-Cap 3 (clearly interrupted and infiltrated PC). A 3D image reconstruction showing MRI-Cap score was provided to both surgeon and pathologist to obtain complete preoperative evaluation and to compare imaging and pathology reports. All patients underwent laparoscopic partial nephrectomy. In surgical specimens, PC was classified according to the renal tumor capsule invasion scoring system (i-Cap).

RESULTS

A concordance between MRI-Cap and i-Cap was found in 50/58 (86%) cases. ρ coefficient for each MRI-cap and iCap categories was: MRI-Cap 0: 0.89 (p < 0.0001), MRI-Cap1: 0.75 (p < 0.0001), MRI-Cap 2: 0.76 (p < 0.0001), and MRI-Cap3: 0.87 (p < 0.0001). Sensitivity, specificity, positive predictive value, negative predictive value, and AUC were: MRI-Cap 0: Se 97.87% Spec 83.3%, PPV 95.8%, NPV 90.9%, and AUC 90.9; MRI-Cap 1: Se 77% Spec 95.5%, PPV 83.3%, NPV 93.5%, and AUC 0.86; MRI-Cap 2- iCap 2: Se 88% Spec 90%, PPV 79%, NPV 95%, and AUC 0.89; MRI-Cap 3: Se 94% Spec 95%, PPV 88%, NPV 97%, and AUC 0.94.

CONCLUSIONS

MRI-Cap classification is accurate in evaluating renal tumor PC features. PC features can provide an imaging-guided landmark to figure out where a minimal margin could be preferable during nephron-sparing surgery.

Clinical utility of 68Ga-DOTATOC positron emission tomography/computed tomography for recurrent renal cell carcinoma

PURPOSE

Positron emission tomography (PET)/computed tomography (CT) with ⁶⁸Ga-labelled 1,4,7,10-tetraazacyclododecane-N,N',N″,N″'-tetraacetic acid-D-Phe¹-Tyr³-octreotide (DOTATOC) has been accepted as a diagnostic imaging tool especially for patients with neuroendocrine tumours. However, its clinical usefulness for restaging of renal cell carcinoma (RCC) has not been fully investigated. This retrospective study was performed to elucidate the clinical value of PET/CT using ⁶⁸Ga-DOTATOC in patients with known or suspected recurrent RCC.

METHODS

We analysed 25 consecutive patients who underwent DOTATOC-PET/CT scans after surgery for RCC (23 clear cell, 1 papillary, 1 unclassified). PET/CT findings were reviewed and the detection rate was calculated on a patient and lesion basis. The detectability was compared in patients who also underwent PET/CT scans with ¹⁸F-fluorodeoxyglucose (FDG). Histopathological findings or clinical follow-up were used as the reference standard.

RESULTS

Based on the final diagnosis, 76 recurrent or metastatic lesions were confirmed in this population. Of these lesions, 66 lesions in 22 patients were positive by DOTATOC-PET/CT. The patient-based and lesion-based sensitivity was 88% (22/25) and 87% (66/76), respectively. Twelve patients underwent both DOTATOC-PET/CT and FDG-PET/CT. The lesion-based sensitivity of DOTATOC was 74% (20/27), while that of FDG was 59% (16/27). Eight lesions were identified only by DOTATOC, but four lesions from papillary RCC were detected only by FDG.

CONCLUSION

Our data indicate that DOTATOC-PET/CT would be useful for detecting recurrent foci in patients with clear cell RCC. DOTATOC-PET/CT and FDG-PET/CT are considered to have complementary roles.

Effect of histopathologic characteristics on pseudocapsular invasion in the case of partial nephrectomy for renal tumours

OBJECTIVE

It is aimed to define the existence of pseudocapsular structure on renal tumours, illuminate the relation between pseudocapsular invasion and Fuhrman grade histological type that are among histopathologic prognostic risk factors and determine the relation between surgical margin positivity and existence of pseudocapsular invasion. Sequential partial nephrectomy series and relevant pathological preparations were retrospectively reviewed in order to evaluate these issues.

METHODS

The study includes 123 patients diagnosed with T1 renal tumour and treated with partial nephrectomy in between January 2007 and June 2016. Benign angiomyolipoma was excluded due to complete non-existence of pseudocapsule. 99 T1 patients diagnosed with renal cell cancer whose pathological slides can be duly analysed were included in the study. Clinical and pathological details were evaluated for all patients. Existence of pseudocapsule was revealed for all patients. Pseudocapsule invasion was classified by existence of expansive and infiltrative type and non-existence of pseudocapsule invasion. The groups have been assessed by their histopathologic characteristics.

RESULTS

Compared to the group in which pseudocapsular invasion was not detected, clear-cell histological subtype was observed more frequently in a statistically significant way in the group with expansive pseudocapsular invasion and infiltrative pseudocapsular invasion respectively (p = 0.017 and p < 0.001). Pathological tumour sizes were found out to be statistically similar (p = 0.874). There was not a statistically significant difference in terms of Fuhrman grade (p = 0.220). There was not a statistically significant difference in terms of surgical positive margin (p = 0.609).

CONCLUSION

It was indicated in our study that only the histological subtype affected pseudocapsular invasion in group of patients treated with partial nephrectomy but tumour size, tumour stage, tumour location as well as endophytic and exophytic character did not affect invasion. It has also been revealed that surgical margin positivity is not correlated with pseudocapsular invasion.

Tumor necrosis as a prognostic variable for the clinical outcome in patients with renal cell carcinoma: a systematic review and meta-analysis

Background

Tumor necrosis (TN) correlates with adverse outcomes in numerous solid tumors. However, its prognostic value in renal cell carcinoma (RCC) remains unclear. In this study, we performed a meta-analysis to evaluate associations between TN and cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS) and progression-free-survival (PFS) in RCC.

Methods

Electronic searches in PubMed, EMBASE and Web of Science were conducted according to the PRISMA statement. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated to evaluate relationships between TN and RCC. A fixed- or random-effects model was used to calculate pooled HRs and 95%CIs according to heterogeneity.

Results

A total of 34 cohort studies met the eligibility criteria of this meta-analysis. The results showed that TN was significantly predictive of poorer CSS (HR = 1.37, 95% CI: 1.23–1.53, p < 0.001), OS (HR = 1.29, 95% CI: 1.20–1.40, p < 0.001), RFS (HR = 1.55, 95% CI: 1.39–1.72, p < 0.001) and PFS (HR = 1.31, 95% CI: 1.17–1.46, p < 0.001) in patients with RCC. All the findings were robust when stratified by geographical region, pathological type, staging system, number of patients, and median follow-up.

Conclusions

The present study suggests that TN is associated with CSS, OS, RFS and PFS clinical outcomes of RCC patients and may serve as a predictor of poor prognosis in these patients.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-4773-z) contains supplementary material, which is available to authorized users.

Evaluation of Tumor Pseudocapsule Status and its Prognostic Significance in Renal Cell Carcinoma

PURPOSE

We determined whether tumor pseudocapsule status, including the extent of invasion by cancer and lack of a pseudocapsule, has prognostic value in renal cell carcinoma.

MATERIALS AND METHODS

We retrospectively reviewed the records of 1,577 patients with different stages of renal cell carcinoma who underwent nephrectomy at our institution, of whom 1,307 (82.9%) were eligible for analysis. Presented pseudocapsules were classified as grade 0-completely intact, grade 1-merely involved and grade 2-penetrated. We studied overall and progression-free survival using the Kaplan-Meier method and a Cox regression model.

RESULTS

Of the 1,307 patients 1,244 (95.2%) presented with a pseudocapsule, including 350 (28.1%), 643 (51.7%) and 251 (20.2%) with a grade 0, 1 and 2 pseudocapsule invasion extent, respectively. Kaplan-Meier curves revealed great losses in overall and progression-free survival for an increased extent of invasion and pseudocapsule absence. On multivariate analyses we identified significant overall and progression-free survival harms for grade 2 pseudocapsules (HR 2.12 and 2.66, each p <0.0001) and lack of a pseudocapsule (HR 1.95, p = 0.0248 and HR 2.54, p = 0.0007, respectively) compared to grade 0 pseudocapsules. A change in statistical risk from grade 1 to 0 was only detected for progression-free survival. The prognostic value of pseudocapsule status was shown by a higher HR on multivariable analyses in individuals with localized renal cell carcinoma.

CONCLUSIONS

Our findings suggest that pseudocapsule status has good prognostic implications in renal cell carcinoma. Lack of a pseudocapsule certainly had a remarkably adverse impact on the patient outcome. Accessibility in use and cost makes pseudocapsule status a potential cost-effective parameter in clinical practice.