Elsevier

Urology

Volume 68, Issue 2, August 2006, Pages 287-291
Urology

Adult urology
Reevaluation of TNM staging of renal cortical tumors: Recurrence and survival for T1N0M0 and T3aN0M0 tumors are equivalent

https://doi.org/10.1016/j.urology.2006.02.012Get rights and content

Abstract

Objectives

The current TNM staging system for renal cortical tumors (RCTs) differentiates between tumors confined to the kidney (T1, T2) and tumors that extend through the renal capsule and invade into the perinephric fat (T3a). We examined the relative survival rates of patients with T1 and T3a tumors to determine the accuracy of the current TNM staging classification.

Methods

We analyzed the Columbia University Surgical Urological Oncology Database for all patients with clinically localized Stage T1, T2, and T3a RCTs treated surgically from 1988 to 2004. The primary outcomes included local and distant recurrence. Because the T3a classification is not limited by size, we compared T3a tumors with T1 tumors alone and tumors confined within the renal capsule (Stage T1 and T2 tumors combined).

Results

A total of 819 patients underwent partial or radical nephrectomy for RCTs at Columbia University during the study period. After the exclusion criteria were applied, 131 patients with T1N0M0, 19 patients with T2N0M0, and 82 patients with T3aN0M0 conventional renal cell carcinoma were eligible for analysis. The median follow-up was 37 months. The median tumor diameter was 3.2, 3.8, and 5.0 cm for Stage T1, T1 and T2 combined, and T3a lesions, respectively. The estimated 5-year disease-free survival was 95.2% and 90.6% for T1 and T3a RCTs, respectively (P = 0.922).

Conclusions

Patients with Stage T3a tumors experienced similar outcomes as patients with tumors confined to the renal capsule. These data suggest that the T3a classification should be examined more closely to attempt to improve the prognostic validity of the TNM classification.

Section snippets

Material and methods

We reviewed the Columbia University Institutional Review Board-approved Urologic Surgical Oncology Database for patients with RCTs treated surgically at Columbia University Medical Center from 1988 to 2004. RCTs were classified according to the 2002 TNM staging classification: T1 tumors, 7.0 cm or less in diameter but confined to the kidney within the renal capsule; T2 tumors, greater than 7.0 cm in diameter but confined to the kidney within the renal capsule; and T3a tumors, extension through

Patient Characteristics

A total of 819 patients underwent radical or partial nephrectomy for renal masses at our institution from 1988 to 2004. After application of the exclusion criteria, 131 T1N0M0, 19 T2N0M0, and 82 T3aN0M0 conventional RCC cases remained for analysis. All tumors were conventional RCC on final pathologic examination. The clinical and demographic characteristics are shown in Table I. The median age was 62 years (range 16 to 88). The median age was 61 years (range 27 to 83) and 63 years (range 16 to

Comment

Since its inception, the AJCC TNM staging system has been the most widely used predictor of kidney cancer recurrence and mortality. Periodic review and revision of staging systems is an important process, and the identification of clinical and pathologic factors that affect survival has the potential to improve the prognostic validity of these classification systems. Debate has been ongoing regarding the current TNM classification for clinically localized RCC. In 2002, the AJCC subclassified

Conclusions

Patients with clinically localized T3aN0M0 tumors without adrenal invasion experienced greater survival compared with patients with T2N0M0 lesions and equivalent outcomes compared with patients with T1N0M0 tumors. Our findings indicate that additional examination of the T3a classification, as defined by the 2002 AJCC TNM staging system for RCT, is warranted. We believe that on the basis of these data, revision of the AJCC TNM T3a classification for kidney cancer merits consideration.

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