Tumor Hilar Proximity may be Predictive of Recurrence, Survival, Stage, and Grade in Patients with Renal Cell Carcinoma

Introduction: Recurrence after nephrectomy for localized renal cell carcinoma (RCC) occurs in up to 30% of patients.This study's aims were twofold: (1) to evaluate whether hilar proximity is associated with disease recurrence, cancer-specific survival (CSS), and overall survival (OS) as a preoperative variable; and (2) to determine whether it correlates with adverse pathological features such as stage and grade. Methods:The Emory Nephrectomy database was reviewed, including patients 18 years with non-metastatic RCC (T1-4N0M0) undergoing radical nephrectomy from 2000-2022, with 36 months follow-up.Tumor-to-hilum distance was classified as proximal (<1 cm) or peripheral (1 cm).Outcomes included 3-year disease-free survival (DFS), CSS, OS, pathological stage, and grade.Multivariable Cox proportional hazards and logistic regression models adjusted for clinicodemographic variables.Results: Among 837 patients, proximal tumors were independently associated with increased recurrence within 3 years (HR 1.86, 95%CI 1.34-2.58,p<0.001) and reduced CSS (HR 2.04, 95%CI 1.28-3.26,p=0.003), without a significant association with OS.Proximal tumors also carried higher odds of pathological stage T3-4 (OR 7.48, 95%CI 5.13-10.91,p<0.001) and Fuhrman grade 3-4 (OR 2.04, 95%CI 1. 43-2.91, p<0.001) Conclusions: Tumor proximity to the renal hilum was discovered to be associated with higher recurrence risk, reduced CSS, and adverse pathological features.Hilar proximity may serve as both a marker and driver of aggressive disease, warranting incorporation into risk stratification models and surveillance strategies.