Impact of pathological T3a upstaging on oncological outcomes of clinical T1 renal cell carcinoma: a meta-analysis

Objective: The study aims to assess the prognostic impact of pathological T3a upstaging in clinical T1 renal cell carcinoma (RCC) on clinical outcomes. Methods: We performed a systematic literature search of PMC, Embase, Web of Science, and Cochrane library from inception to April 2019 for studies that investigated the prognostic significance of pathological T3a upstaging in clinical T1 RCC after surgery and conducted a standard meta-analysis on survival outcomes. Results: Overall, nine studies including 101,505 clinical T1 RCC patients were identified, in which 5,560 (5.5%) patients were upstaged to T3a after surgical treatment. Meta-analysis results showed that pT3a upstaging from clinical T1 RCC was significantly associated with poor recurrence-free survival (RFS; pooled hazard ratio [HR] 2.16, 95% confidence interval [CI] 1.70-2.75; P<0.001), overall survival (OS; pooled HR 1.36, 95% CI 1.24-1.50; P<0.001), and cancer-specific survival (CSS; pooled HR 2.11, 95% CI 1.58-2.83; P<0.001). Subgroup analyses by surgical type demonstrated that pT3a upstaging remains a significant prognostic factor for RFS and OS in RCC patients who underwent different surgical treatments. Conclusions: Current available evidence strongly supported that postoperative pT3a upstaging has a significant negative impact on RFS, OS, and CSS in clinical T1 RCC patients. Clinical T1 RCC patients with pT3a upstaging after surgery should be closely monitored by clinician and should receive close follow-up for their poor prognosis.