CURRENT TNM CLASSIFICATION OF RENAL CELL CARCINOMA EVALUATED: REVISING STAGE T3a

Siemer, Stefan; Lehmann, Jan; Loch, A.; Becker, Frank; Stein, Ulrike; Schneider, Guenther; Ziegler, M.; Stöckle, Michael

doi:10.1097/01.ju.0000146719.43269.e8

Cited by 93 publications

(60 citation statements)

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“…Patients with adrenal gland involvement have significantly worse survival than those with peri-renal fat involvement (Hank et al, 2003;Siener et al, 2005). Direct ipsilateral adrenal gland involvement in RCC is rare, found only in 2.5% of radical nephrectomy specimens (Hank et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic Patterns of Adult Renal Tumors in Pakistan

Hashmi

Ali²,

Hussain³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Renal cancer is a serious public health problem which may be under reported and registered in our setup, since the Karachi cancer registry documented only 43 cases out of 4,268 incident cancer cases over 3 year duration. Therefore we aimed to determine the clinicopathologic characteristics of adult renal tumors in our setup. Materials and Methods: The study was conducted in histopathology department, Liaquat National Hospital and included total of 68 cases of adult renal tumors over 4 years. Detailed histopathologic characteristics of tumors were analyzed. Results: Mean age of patients was 56.4 (18-84) years. Renal cell carcinoma (RCC) was the most common cell type (78%) cases; followed by transitional/urothelial carcinoma (12.5%), leiomyosarcoma (4.7%), oncocytoma (1.6%), squamous cell carcinoma (1.6%) and high grade pleomorphic undifferentiated sarcoma (1.6%). Among 50 RCC cases; 62% were conventional/clear cell RCC (CCRCC) type followed by papillary RCC(PRCC), 24%; chromophobe RCC(CRCC), 6% and sarcomatoid RCC(SRCC), 8%. Mean tumor size for RCC was 7.2 cm. Most RCCs were intermediate to high grade (60% and 40% respectively). Capsular invasion, renal sinus invasion, adrenal gland involvement and renal vein invasion was seen in 40%, 18%, 2% and 10% of cases respectively. Conclusions: We found that RCC presents at an earlier age in our setup compared to Western populations. Tumor size was significantly larger and most of the tumors were of intermediate to high grade. This reflects late presentation of patients after disease progression which necessitates effective measures to be taken in primary care setup to diagnose this disease at an early stage.

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Section: Discussionmentioning

confidence: 99%

Clinicopathologic Patterns of Adult Renal Tumors in Pakistan

Hashmi

Ali²,

Hussain³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…39,40 A study by Huang and colleagues found that a total of 192 out of 662 patients (29%) developed a new onset of GFR lower than 60 mL/min/1.73m 2 and 105 out of 662 patients (16%) developed new onset of GFR lower than 45 mL/min/1.73m 2 following nephrectomy. 41 This study supports the notion that patients who undergo a RN have a significantly higher risk of developing moderately severe CKD and therefore may expe- renal function after partial or radical nephrectomy for rCC rience negative effects on life span and quality of life.…”

Section: What Is Known About Renal Function After Nephrectomy In Humans?mentioning

confidence: 99%

Residual renal function after partial or radical nephrectomy for renal cell carcinoma

Chapman

Moore

Klarenbach

et al. 2013

CUAJ

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Renal cell carcinoma (RCC) is often detected incidentally and early. Currently, open partial nephrectomy and laparoscopic total nephrectomy form competing technologies. The former is invasive, but nephron-sparing; the other is considered less invasive but with more loss of renal mass. Traditionally, emphasis has been placed on oncologic outcomes. However, a patient with an excellent oncologic outcome may suffer from morbidity and mortality related to renal failure. Animal models with hypertension and diabetic renal disease indicate accelerated progression of pre-existing disease after nephrectomy. Patients with RCC are older and they have a high prevalence of diabetes and hypertension. The progression of renal failure may also be accelerated after a nephrectomy. Our analysis of the available literature indicates that renal outcomes in RCC patients after surgery are relatively poorly defined. A strategy to systematically evaluate the renal function of patients with RCC, with joint discussion between the nephrologist and the oncologic team, is strongly advocated.Can Urol Assoc J 2010;4(5):337-343 Résumé L'hypernéphrome est souvent décelé fortuitement et au stade pré-coce. Actuellement, la néphrectomie partielle par voie ouverte et la néphrectomie totale par laparoscopie sont des technologies concurrentes. Tandis que la première est plus invasive, mais permet l'épargne des néphrons, la seconde est moins invasive mais entraîne une perte plus importante de masse rénale. Par le passé, on a mis l'emphase sur les résultats d'un point de vue oncologique. Cependant, un patient pour qui la chirurgie donne d'excellents résul-tats en matière d'élimination de la tumeur pourrait présenter une morbidité et une mortalité en lien avec une insuffisance rénale. Des modèles animaux de néphropathie avec hypertension et diabète indiquent une évolution accélérée des maladies préexistantes après la néphrectomie. Les patients présentant un hypernéphrome sont plus âgés; la prévalence du diabète et de l'hypertension est élevée. L'évolution de l'insuffisance rénale peut aussi être accélérée après la néphrectomie. Notre analyse des articles publiés montre que les résultats sur le plan de la fonction rénale après une chirurgie pour traiter un hypernéphrome sont relativement mal définis. Une straté-gie fondée sur une évaluation systématique de la fonction rénale des patients atteints d'hypernéphrome, avec discussion entre le néphro-logue et l'équipe de soins oncologiques, est fortement encouragée.

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“…Primary adrenal carcinoma that invades the kidney is classified as pT4 disease (Ng & Libertino, 2003;Norton et al, 2005). A number of previous reports have suggested that, analogously, RCC with adrenal gland involvement should be reclassified as 2002-pT4 (Sandock et al, 1997;Han et al, 2003;Siemer et al, 2005;. Based on these investigations, adrenal gland involvement has been classified pT4 in 2009 AJCC TNM staging classification (Edge et al, 2009 …”

Section: Adrenal Gland Involvement In Rccmentioning

confidence: 99%

“…Patients with adrenal gland involvement have significantly worse survival than those with perirenal fat involvement (Han et al, 2003;Siemer et al, 2005). Direct ipsilateral adrenal gland involvement in RCC is rare, found in only 2.5% of radical nephrectomy specimens, and representing 13% of all 2002-pT3a lesions (Han et al, 2003).…”

Section: Adrenal Gland Involvement In Rccmentioning

confidence: 99%

“…In this study, there were too few patients with RCCs exhibiting tumor thrombus with perirenal fat or adrenal gland involvement to allow a comparison of survival for patients with adrenal gland or perirenal fat involvement. However, previous investigators have emphasized that adrenal gland involvement should reclassified because of the worse prognosis (Han et al, 2003;Siemer et al, 2005;Fujita et al, 2008). According to the 2002 AJCC TNM staging classification (Greene et al, 2002), pT4 RCC is defined as tumor invades beyond Gerota's fascia.…”

Section: Adrenal Gland Involvement In Rccmentioning

confidence: 99%

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