Prognostic features of pathologic stage T1 renal cell carcinoma after radical nephrectomy

doi:10.1016/S0090-4295(01)01589-8

Urology

Volume 59, Issue 4, April 2002, Pages 532-537

https://doi.org/10.1016/S0090-4295(01)01589-8 Get rights and content

Abstract

Objectives. To assess the effect of renal cell carcinoma (RCC) subtype, tumor size, and Fuhrman grade on clinical outcome in patients with pathologic T1 (pT1) RCC treated with radical nephrectomy.

Methods. Between 1970 and 1998, 840 patients underwent radical nephrectomy for pT1 RCC. Tumors were subtyped and graded. Univariate and multivariate Cox proportional hazards models were fitted to assess the features associated with metastasis-free survival (MFS) and cancer-specific survival (CSS). We identified a range of tumor sizes of clear cell RCC in which a transition occurred from low to high risk. Cox proportional hazards models were then fitted by using size cutoffs.

Results. The mean follow-up (± SD) was 9.4 ± 6.6 years among the patients alive at latest follow-up. At 10 years, the CSS and MFS for clear cell RCC (n = 682) were 89.1% and 88.6%, respectively; for papillary RCC (n = 122), they were 95.5% and 93.8%; and for chromophobe RCC (n = 33), they were both 100%. The differences in CSS (P = 0.013) and MFS (P = 0.023) between clear cell RCC and the other subtypes were statistically significant. For clear cell RCC, tumor size and Fuhrman grade were independently associated with CSS and MFS (P <0.001). A transition in risk occurred for tumor sizes between 4.5 and 5.0 cm, and the tumor size cutoff of 5.0 cm had the highest concordance index for predicting CSS and MFS.

Conclusions. RCC subtype is a strong independent prognostic variable for patients with pT1 RCC treated with radical nephrectomy. For clear cell RCC, Fuhrman grade and tumor size are independently associated with CSS and MFS.

Section snippets

Material and methods

Between 1970 and 1998, 840 consecutive patients (532 men, 308 women; mean age ± SD, 63.3 ± 11.3 years) underwent radical nephrectomy for sporadic pT1 RCC at our institution. Patients were excluded if they had lymph node and distant metastasis at presentation, had undergone previous surgical procedures, or had bilateral synchronous tumors, multiple RCC tumors, hereditary RCC, such as von Hippel-Lindau syndrome, familial papillary RCC, or RCC related to tuberous sclerosis. Among the 840 patients

Results

Among the 840 patients with pT1 RCC, 682 (81.2%) had clear cell (conventional) RCC, 122 (14.5%) had papillary RCC, 33 (3.9%) had chromophobe RCC, and 3 (0.4%) had RCC not otherwise specified. The results are reported separately for clear cell, papillary, and chromophobe RCC. Patient and tumor characteristics are summarized in Table I by histologic subtype. The median follow-up among the patients alive at latest follow-up with clear cell, papillary, and chromophobe RCC was 8.2, 7.8, and 7.1

Comment

In our study, RCC subtype was significantly associated with CSS and MFS in patients with pT1 RCC. In addition, tumor size and Fuhrman grade were significantly associated with CSS and MFS in patients with clear cell RCC, and the tumor cutoff of 5 cm identified patients at low and high risk of tumor progression and death from RCC. Pathologic stage, nuclear grade, and histologic RCC subtype are considered important factors associated with prognosis for RCC.6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17

Conclusions

RCC histologic subtype is an important prognostic feature. In clear cell RCC, tumor size and Fuhrman grade are strong independent prognostic variables for patients who have pT1 RCC treated with radical nephrectomy. The tumor size cutoff of 5.0 cm is useful for subclassification of T1 tumors into T1a (less than 5 cm) and T1b (5 to 7 cm). On the basis of this study, stratification of patients with T1 clear cell RCC into prognostic subgroups would be useful. It would facilitate better patient

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To compare the predictive ability for oncologic outcomes among current tumor size cut-points and clinically relevant alternatives to determine which are optimal.
Patients who underwent radical or partial nephrectomy between 1970 and 2010 for T1-2Nx/N0M0 renal cell carcinoma (RCC) were identified. Associations between tumor size and progression-free survival (PFS) and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analyses and Cox models. Predictive ability was assessed using c-indexes.
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To characterize the original SSIGN score cohort with longer follow-up and evaluate a contemporary series of patients treated with RN and PN.
Retrospective single-institution review of 3600 consecutive surgically treated ccRCC patients grouped into three cohorts: original RN, contemporary (1999–2010) RN, and contemporary PN.
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The SSIGN scores differed significantly between the original RN, contemporary RN, and contemporary PN cohorts (p < 0.001), with SSIGN ≥4 in 53.5%, 62.7%, and 4.7%, respectively (p < 0.001). The median durations of follow-up for these groups were 20.1, 9.2, and 7.6 yr, respectively. Each increase in the SSIGN score was predictive of death from RCC (hazard ratios [HRs]: 1.41 for original RN, 1.37 for contemporary RN, and 1.70 for contemporary PN; all p < 0.001). The C-indexes for these models were 0.82, 0.84, and 0.82 for original RN, contemporary RN, and contemporary PN, respectively. After accounting for an era-specific improvement in survival among RN patients (HR: 0.53 for contemporary vs original RN; p < 0.001), the SSIGN score remained predictive of death from RCC (HR: 1.40; p < 0.001).
The SSIGN score remains a useful prediction tool for patients undergoing RN with 20-yr follow-up. When applied to contemporary RN and PN patients, the score retained strong predictive ability. These results should assist in patient counseling and help guide surveillance for ccRCC patients treated with RN or PN.
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Malignancies will be a leading cause of mortality in renal transplant recipients in the next 20 years. Renal cell cancer (RCC) is the most common urologic cancer in kidney transplant recipients. The risk of RCC development in kidney transplant recipients is 15–100 times higher than in the general population. The purpose of the current retrospective study was to assess the frequency of nephrectomies performed because of renal tumors in the native kidneys in kidney transplant recipients in the Department of General and Transplantation Surgery at the Medical University of Warsaw between 2010 and 2014 year; the identification of kidney recipients diagnosed with RCC; and epidemiologic, clinical, and histopathological aspects associated with RCC.
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Adult urologyPrognostic features of pathologic stage T1 renal cell carcinoma after radical nephrectomy

Abstract

Section snippets

Material and methods

Results

Comment

Conclusions

J Urol

J Urol

J Urol

J Urol

J Urol

J Urol

J Urol

Urology

Urol Clin North Am

J Urol

J Urol

J Urol

TNM Classification of Malignant Tumors, 5th ed (1997)

Cancer

Tumor size of renal cell carcinomaits clinical implication

Urol Int

Adult urology
Prognostic features of pathologic stage T1 renal cell carcinoma after radical nephrectomy