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