Adult urologyPrognostic features of pathologic stage T1 renal cell carcinoma after radical nephrectomy
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
References (28)
- et al.
The impact of tumor size on clinical outcome in patients with localized renal cell carcinoma treated by radical nephrectomy
J Urol
(1997) - et al.
Renal cell carcinomatumor size, stage and survival
J Urol
(1995) - et al.
Value of tumor size in predicting survival from renal cell carcinoma among tumors, nodes and metastases stage 1 and stage 2 patients
J Urol
(1994) - et al.
Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery
J Urol
(1996) - et al.
Reevaluation of the 1997 TNM classification for renal cell carcinomaT1 and T2 cutoff point at 4.5 cm rather than 7 cm better correlates with clinical outcome
J Urol
(2001) - et al.
A postoperative prognostic nomogram for renal cell carcinoma
J Urol
(2001) - et al.
The impact of a 4 cm cutoff point for stratification of T1N0M0 renal cell carcinoma after radical nephrectomy
J Urol
(2001) - et al.
Role of nuclear grading in stage I renal cell carcinoma
Urology
(1989) - et al.
Prognostic factors in renal cancer
Urol Clin North Am
(1993) - et al.
Nephron sparing surgery for localized renal cell carcinomaimpact of tumor size on patient survival, tumor recurrence and TNM staging
J Urol
(1999)
Radical nephrectomy for renal cell carcinoma 30 mm or lesslong-term follow-up results
J Urol
Chromophobe cell renal carcinomaclinicopathological features of 50 cases
J Urol
TNM Classification of Malignant Tumors, 5th ed (1997)
Cancer
Tumor size of renal cell carcinomaits clinical implication
Urol Int
Cited by (110)
Lymph Node Dissection for Small Renal Masses
2017, Urologic Clinics of North AmericaRenal Tumor in Allogeneic Kidney Transplant Recipient
2016, Transplantation ProceedingsClassification of Histologic Patterns of Pseudocapsular Invasion in Organ-Confined Renal Cell Carcinoma
2016, Clinical Genitourinary Cancer