From the Guidelines
Grade 3, pT3 renal cell carcinoma is an aggressive form of kidney cancer with a 5-year survival rate of 59% and requires radical nephrectomy followed by consideration of adjuvant therapy, with a recommended surveillance schedule including regular imaging and monitoring of kidney function. The prognosis for a patient with this condition is guarded due to its high grade and advanced T3 stage, indicating poorly differentiated, aggressive cells and local invasion. Treatment decisions should be individualized, taking into account the patient's overall health, comorbidities, and performance status.
- The patient's cancer stage and grade will guide the treatment approach, with radical nephrectomy being the primary treatment option for pT3 tumors 1.
- Adjuvant immunotherapy with pembrolizumab may be considered for eligible patients to improve disease-free survival, as shown in recent studies 1.
- Surveillance after treatment is crucial, with a recommended schedule including regular imaging (CT scans every 3-6 months initially, then annually), blood work to monitor kidney function, and physical examinations 1.
- Lifestyle modifications, such as smoking cessation, maintaining a healthy weight, and controlling blood pressure, are also important components of care to improve overall outcomes.
- The patient should be monitored for at least 5 years, with most recurrences happening within the first 3 years, and the risk of recurrence should be discussed with the patient to ensure informed decision-making 1.
From the FDA Drug Label
Table 14 Disease-free Survival by Baseline Disease Characteristics Number of Events/Total n/N Median DFS [years (95% CI)] HR a (95% CI) Sunitinib Placebo Sunitinib Placebo T3 Intermediate b 35/115 46/112 NR (5.2, NR) 6.4 (4.7, NR) 0.82 (0.53,1.28) T3 High c 63/165 79/166 6.8 (5.0, NR) 5.3 (2.9, NR) 0.77 (0.55,1.07)
The prognosis for a patient with grade 3, pathological T3 (pT3) renal cell carcinoma is not directly stated in the provided text. However, based on the information provided in Table 14, we can see that the median disease-free survival (DFS) for patients with T3 high risk disease (which includes grade 3) is 6.8 years for patients treated with sunitinib, compared to 5.3 years for patients treated with placebo. The hazard ratio (HR) for DFS is 0.77, indicating a reduced risk of disease recurrence in patients treated with sunitinib. 2
From the Research
Prognosis for Grade 3, Pathological T3 (pT3) Renal Cell Carcinoma
- The prognosis for a patient with grade 3, pathological T3 (pT3) renal cell carcinoma is influenced by various factors, including tumor size, histology, and surgical treatment approach 3.
- A study comparing oncologic and functional outcomes in patients with pT3a renal cell carcinoma treated with partial and radical nephrectomy found no statistically significant differences in overall survival, cancer-specific survival, or recurrence-free survival between the two treatment groups 3.
- However, another study suggested that upstaging to pT3a in patients undergoing partial or radical nephrectomy for cT1 renal tumors is associated with worse oncological outcomes, including lower 5-year recurrence-free survival and overall survival 4.
- Predictors of upstaging from cT1 to pT3a renal masses include older age, male sex, larger tumor size, higher tumor complexity, and higher Fuhrman grade 4.
- The treatment of advanced or metastatic renal cell carcinoma has evolved with the advent of antiangiogenic drugs and tyrosine-kinase inhibitors, which have improved survival rates 5.
- In patients with advanced clear cell renal carcinoma, pazopanib has been shown to be an active agent, even after failure of sunitinib or bevacizumab, with a median progression-free survival of 7.5 months and an estimated overall survival rate of 43% at 24 months 6.
- A risk-adjusted proposal for follow-up after surgical treatment of organ-confined renal cell carcinoma suggests that one-third of recurrences occur after 60 months, and recommends an age-adjusted strategy of follow-up balancing the risk of tumor recurrence and life expectancy 7.