Pathologic T3a renal cell carcinoma: a classification in need of further refinement

Kidney cancer is associated with a significant global disease burden (1,2). Although mortality rates for renal cell carcinoma (RCC) in the United States remain stable, the incidence of RCC continues to rise, largely due to increased incidental detection on routine abdominal imaging (1,3). Ultimately, both treatment recommendations and patient prognosis are based on the stage of disease (4,5). Pathologic staging of RCC continues to be refined, especially for the characterization of pathologic T3a (pT3a) disease, which represents locally advanced disease with invasion of the fat or vasculature of the kidney, and is associated with worse oncologic outcomes compared to organ confined disease (6,7).