Quantitative tumour necrosis is an independent predictor of overall survival in clear cell renal cell carcinoma

Renshaw, Andrew A.; Cheville, John C.

doi:10.1097/pat.0000000000000193

Cited by 14 publications

(8 citation statements)

References 27 publications

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“…The quantity of tumour necrosis has been reported to affect the prognostic significance, not simply its presence [ 84 – 86 ]. However, although it has been recommended that the proportion of necrosis is recorded in histology reports, there is no international agreement as yet on how this can be reliably assessed pathologically [ 5 ].…”

Section: Resultsmentioning

confidence: 99%

WHO/ISUP classification, grading and pathological staging of renal cell carcinoma: standards and controversies

2018

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Section: Resultsmentioning

confidence: 99%

WHO/ISUP classification, grading and pathological staging of renal cell carcinoma: standards and controversies

2018

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“…This is somewhat unfortunate, as these do not differentiate between ‘microscopic’ (tumour‐related) and ‘macroscopic’ (coagulative) necrosis, recommending that both should be reported. There is good evidence that the presence of tumour‐related necrosis is associated with an unfavourable prognosis in both clear cell and chromophobe RCC, and because of this the presence or absence of necrosis within a clear cell RCC has been incorporated into various prognostic nomograms . The prognostic significance of infarct‐related coagulative necrosis is less certain, and results to date have been conflicting.…”

Section: Future Developmentsmentioning

confidence: 99%

“…There is good evidence that the presence of tumour-related necrosis is associated with an unfavourable prognosis in both clear cell and chromophobe RCC, and because of this the presence or absence of necrosis within a clear cell RCC has been incorporated into various prognostic nomograms. [86][87][88] The prognostic significance of infarctrelated coagulative necrosis is less certain, and results to date have been conflicting. As some studies have indicated that the percentage of necrosis present within a tumour has prognostic significance, the ICCR further recommends that the percentage of necrosis present should be reported.…”

Section: Future Developmentsmentioning

confidence: 99%

Grading of renal cell carcinoma

Delahunt¹,

et al. 2018

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Grading of renal cell carcinoma (RCC) has been recognised as a prognostic factor for almost 100 years. Numerous grading systems have been proposed, initially focusing upon a constellation of cytological features and more recently on nuclear morphology. It has been recommended that grading of RCC should be based upon nucleolar prominence/eosinophilia for grades 1–3, while grade 4 requires nuclear anaplasia (including tumour giant cells, sarcomatoid differentiation and/or rhabdoid morphology). The grading system was adopted formally by the International Society of Urological Pathology (ISUP) and subsequently by the World Health Organisation (WHO), being designated the WHO/ISUP grading classification in the fourth edition of the WHO classification tumours of the urinary system and male genital organs (2016). This grading system has been validated for both clear cell and papillary RCC. Validation studies for chromophobe RCC failed to demonstrate a correlation between grade and outcome for both the superseded Fuhrman grading system and the WHO/ISUP grading classification, and it has been recommended that these tumours not be graded. The WHO/ISUP system has been incorporated into the structured reports of the International Cancer Collaboration on Cancer Reporting for both clear cell and papillary RCC. It is also noted that other types of RCC may be graded, but it must be emphasised in the report that this is for descriptive and diagnostic purposes, and not outcome prediction. More recent studies have shown the incorporation of the presence of tumour necrosis into RCC grading to improve outcome prediction, and this has been validated in several studies.

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“…The presence or absence, as well as the percentage of tumour showing MCN, has been correlated with surrogate prognostic markers and patient outcome. 59,61,63 It is unfortunately evident that several studies have confused the two types of necrosis and the current recommendations of both the ISUP and the WHO are that both types of necrosis should be recorded, which serves to confound prognostic assessment. Separate studies relating to tumour outcome have shown that the MCN provides survival information additional to tumour grading, and for this reason it has been suggested that MCN status should be incorporated into the WHO/ISUP grading classification for clear cell RCC.…”

Section: Discussionmentioning

confidence: 99%

Data set for the reporting of carcinoma of renal tubular origin: recommendations from the International Collaboration on Cancer Reporting (ICCR)

et al. 2019

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Aims The International Collaboration on Cancer Reporting (ICCR) has provided detailed data sets based upon the published reporting protocols of the Royal College of Pathologists, the Royal College of Pathologists of Australasia and the College of American Pathologists. Methods and results The data set for carcinomas of renal tubular origin treated by nephrectomy was developed to provide a minimum structured reporting template suitable for international use, and incorporated recommendations from the 2012 Vancouver Consensus Conference of the International Society of Urological Pathology (ISUP) and the fourth edition of the World Health Organisation Bluebook on tumours of the urinary and male genital systems published in 2016. Reporting elements were divided into those, which are required and recommended components of the report. Required elements are: specimen laterality, operative procedure, attached structures, tumour focality, tumour dimension, tumour type, WHO/ISUP grade, sarcomatoid/rhabdoid morphology, tumour necrosis, extent of invasion, lymph node status, surgical margin status, AJCC TNM staging and co‐existing pathology. Recommended reporting elements are: pre‐operative treatment, details of tissue removed for experimental purposes prior to submission, site of tumour(s) block identification key, extent of sarcomatoid and/or rhabdoid component, extent of necrosis, presence of tumour in renal vein wall, lymphovascular invasion and lymph node status (size of largest focus and extranodal extension). Conclusions It is anticipated that the implementation of this data set in routine clinical practice will inform patient treatment as well as provide standardised information relating to outcome prediction. The harmonisation of data reporting should also facilitate international research collaborations.

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Quantitative tumour necrosis is an independent predictor of overall survival in clear cell renal cell carcinoma

Cited by 14 publications

References 27 publications

WHO/ISUP classification, grading and pathological staging of renal cell carcinoma: standards and controversies

WHO/ISUP classification, grading and pathological staging of renal cell carcinoma: standards and controversies

Grading of renal cell carcinoma

Data set for the reporting of carcinoma of renal tubular origin: recommendations from the International Collaboration on Cancer Reporting (ICCR)

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