Clinico-pathological analysis of renal cell carcinoma demonstrates decreasing tumour grade over a 17-year period

Abstract

Introduction: Renal cell carcinoma (RCC) represents about 3% of adult malignancies in Ireland. Worldwide there is a reported increasing incidence and recent studies report a stage migration towards smaller tumours. We assess the clinico-pathological features and survival of patients with RCC in a surgically treated cohort. Methods: A retrospective analysis of all nephrectomies carried out between 1995 and 2012 was carried out in an Irish tertiary referral university hospital. Data recorded included patient demographics, size of tumour, tumour-node-metastasis (TNM) classification, operative details and final pathology. The data were divided into 3 equal consecutive time periods for comparison purposes: Group 1 (1995)(1996)(1997)(1998)(1999)(2000), Group 2 (2001Group 2 ( -2006 and Group 3 (2007Group 3 ( -2012. Survival data were verified with the National Cancer Registry of Ireland. Results: In total, 507 patients underwent nephrectomies in the study period. The median tumour size was 5.8 cm (range: 1.2-20 cm) and there was no statistical reduction in size observed over time (p = 0.477). A total of 142 (28%) RCCs were classified as pT1a, 111 (21.9%) were pT1b, 67 (13.2%) were pT2, 103 (20.3%) were pT3a, 75 (14.8%) were pT3b and 9 (1.8%) were pT4. There was no statistical T-stage migration observed (p = 0.213). There was a significant grade reduction over time (p = 0.017). There was significant differences noted in overall survival between the T-stages (p < 0.001), nuclear grades (p < 0.001) and histological subtypes (p = 0.022). Conclusion: There was a rising incidence in the number of nephrectomies over the study period. Despite previous reports, a stage migration was not evident; however, a grade reduction was apparent in this Irish surgical series. We can demonstrate that tumour stage, nuclear grade and histological subtype are significant prognosticators of relative survival in RCC.

Changing the Stage, Grade and Histological Subtypes of Renal Cell Carcinomas during 10 Years Period

“…The patients with organ confined tumours (pT1 and pT2) have decreased from 83.6 to 72.5%, in the contrary, pT1b tumours were increased from 24.4 to 29.7% in our study. The authors reported that the incidence of organ confined tumour was increased from 36.9 to 73.2% during the 27 years (Pichler et al, 2012); the other study demonstrated that the percentage of organ confined tumours was 66.7, 56.2 and 65.6% in the three study group respectively (Nason et al, 2014). The patients with local advanced tumours (pT3 and pT4) have increased during the study period (from 16.2 to 27.3%).…”

“…The authors observed a decrease in pathological pT3 and pT4 RCC patients from 29.1 to 20.5% over two decades (Gupta et al, 2010). The patients with local advanced RCC have increased during the seventeen years period (from 33.3 to 34.4%) in another study (Nason et al, 2014). One of the reasons of increasing numbers of patients with local advanced tumour: our hospital is tertiary referral centre.…”

“…118 (2017) No. 4, p. 119-127 There has been an increasing incidence of renal cell carcinomas, as a result of more prevalent use of imaging techniques, such as ultrasonography, computed tomography and magnetic resonance imaging in recent years (Nason et al, 2014).…”

Platelet to white blood cell ratio predicts 30-day postoperative infectious complications in patients undergoing radical nephrectomy for renal malignancy

“…37 This has led to a stage migration overall towards lower stage of disease at time of diagnosis. 38 In order to provide clinically-meaningful interpretations of PLT/WBC ratio, we used quintiles. However, future research may identify more informative ways to operationalize this variable such as a dichotomous threshold.…”

Solidifying prognosis after surgery for renal cell carcinoma

“…1 Newer series such as this one have renewed value in that they may provide a window into RCC outcomes in an era when the peculiarities of the small renal mass (SRM) have gained prominence. 2 The increasing incidence of RCC, attributed in large part to increased abdominal imaging, has typically accompanied a downward stage migration, with smaller incident masses and the expectation of lower stage and grade.…”