Radical Extensive Surgery for Renal Cell Carcinoma: Long-Term Results and Prognostic Factors

Giuliani, L.; Giberti, Claudio; Martorana, Giuseppe; Rovida, S

doi:10.1016/s0022-5347(17)39992-5

Cited by 272 publications

(105 citation statements)

References 30 publications

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“…'s study, eighty-seven cases of chromophobe renal cell carcinoma were investigated. Authors emphasized that the fact that all the 8 dead chromophobe RCC patients had FNG-2, supports this opinion (13)(14)(15)(16)(17). According to our observations, tissue fixing is a misleading factor that complicates the evaluation.…”

Section: Discussionsupporting

confidence: 72%

The Relationship of Fuhrman Nuclear Grade, Tumor Stage and Sarcomatoid Differentiation with Survival in Renal Cell Carcinomas

Tastekin¹,

Puyan²,

Kaplan³

et al. 2012

Balkan Med J

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Objective: Renal cell carcinoma derived from tubular epithelium is one of the malignant tumors of the kidney. We have investigated the histological features, pathological stage, nuclear grade and sarcomatoid differentiation of these tumors. Results: In our study, cases with high nuclear grade, advanced stage and sarcomatoid differentiation revealed poor survival rates (p<0.05). In conclusion, the correlation between prognostic histopathological parameters and survival rates was consistent with literature findings.Conclusion: Fuhrman nuclear grading, stage and sarcomatoid differentiation are important parameters and are related factors in survival when investigating renal cell carcinomas. Fuhrman nuclear grading must be evaluated correctly and the highest grade should be reported. Although there aren't enough studies about sarcomatoid differentiation, its presence significantly decreases survival rates. It is very important to state histopathological parameters including sarcomatoid differentiation precisely on the pathology report.

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Section: Discussionsupporting

confidence: 72%

The Relationship of Fuhrman Nuclear Grade, Tumor Stage and Sarcomatoid Differentiation with Survival in Renal Cell Carcinomas

Tastekin¹,

Puyan²,

Kaplan³

et al. 2012

Balkan Med J

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“…This rate was similar to that of patients with pT3N0M0 tumors and was significantly higher than the 7% observed for patients with distant metastases. 107 In this study they also found that the number of involved nodes (1 vs 42 nodes) did not correlate with outcome. In later survival studies nodal involvement (N0 vs N1-3) was found to confer an unfavorable prognosis and this was shown to retain significance along with patient age and pT category, on multivariate analysis.…”

Section: Lymph Node Metastasesmentioning

confidence: 49%

“…114,115 It has also been shown that although lymph node dissection is associated with increased survival in the short term-with an increased median survival of 5 months, this advantage was lost over a 5-year follow-up period. 115 Lymph node metastases have been reported in 9-27% of cases of RCC, 107 however, evaluation of the role of lymph node dissection in the management of patients with RCC is hampered by the relative scarcity of patients with lymph node metastases in the absence of extranodal tumor spread. This is highlighted by autopsy studies on patients with clinically unrecognized disease, where only 4.2% of cases were found to have metastases confined to lymph nodes.…”

Section: Lymph Node Metastasesmentioning

confidence: 99%

Advances and controversies in grading and staging of renal cell carcinoma

2009

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Despite the considerable progress made in our understanding of the pathogenesis, genetics, and pathology of renal cell carcinoma (RCC), difficulties remain relating to the prediction of clinical outcome for individual cases. Although there is evidence to show that high-grade tumors have a poorer prognosis when compared to those of low grade, debate remains regarding the predictive value of grading, especially for those tumors classified into the intermediate grades. Numerous composite morphologic and nuclear grading systems have been proposed for RCC and although that of the Fuhrman classification have achieved widespread usage, the validity of the grading criteria of this classification has been questioned. In addition, there are few studies that have attempted to validate the Fuhrman system for RCCs beyond that of the clear cell subtype. Recent studies have indicated that grading of papillary RCC should be based on nucleolar prominence alone and that the components of the Fuhrman grading classification do not provide prognostic information for chromophobe RCC. Independent of tumor grade, the prognostic importance of tumor stage for RCC is well recognized. The Union Internationale Contre le Cancer/American Joint Committee for Cancer Staging and End Results Reporting TNM staging system is now in its sixth edition (2002) and recent refinements have focused on defining size cut points that will identify apparently localized tumors that will develop recurrence and/or metastases despite attempted curative surgery. In parallel with these studies it has been shown that infiltration of the renal sinus is an important prognostic factor, being observed in almost all tumors 47 cm in diameter. Questions remain as to the appropriate stratification of regional extension of RCC, as defined in the T3 tumor-staging category. Recent modifications to this category have been suggested combining the level of infiltration of the venous outflow tract with the presence or absence of infiltration of the adrenal gland and/or perirenal fat. Similarly, the utility of classifying lymph node involvement by tumor is debated, although it is well recognized that lymph node infiltration is associated with a poor prognosis. Although the current TNM classification does provide useful prognostic information it would appear that further modifications are justified to enhance the predictive value of staging for RCC.

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“…The reported survival rate of patients with exclusive NM demonstrates great variability, and ranges from 5 to 40%. [3][4][5][6][7][8][9] Even after consideration of staging biases, these survival rates are in clear contrast with survival estimates from patients with localized disease (T 1-3 N 0 M 0 ), where 5-year survival exceeds 85%. Therefore, patients with NM have clearly more aggressive disease than even the worst variant of localized disease.…”

mentioning

confidence: 91%

Patients with renal cell carcinoma nodal metastases can be accurately identified: External validation of a new nomogram

Hutterer

Patard

Perrotte

et al. 2007

Intl Journal of Cancer

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Outcome of patients with renal cell carcinoma nodal metastases (NM) is substantially worse than that of patients with localized disease. This justifies more thorough staging and possibly more aggressive treatment in those at risk of or with established NM. We developed and externally validated a nomogram capable of highly accurately predicting renal cell carcinoma NM in patients without radiographic evidence of distant metastases. Age, symptom classification, tumour size and the pathological nodal stage were available for 4,658 individuals. The data of 2,522 (54.1%) individuals from 7 centers were used to develop a multivariable logistic regression model-based nomogram predicting the individual probability of NM. The remaining data from 2,136 (45.9%) patients from 5 institutions were used for external validation. In the development cohort, 107/2,522 (4.2%) had lymph node metastases vs. 100/2,136 (4.7%) in the external validation cohort. Symptom classification and tumour size were independent predictors of NM in the development cohort. Age failed to reach independent predictor status, but added to discriminant properties of the model. A nomogram based on age, symptom classification and tumour size was 78.4% accurate in predicting the individual probability of NM in the external validation cohort. Our nomogram can contribute to the identification of patients at low risk of NM. This tool can help to risk adjust the need and the extent of nodal staging in patients without known distant metastases. More thorough staging can hopefully better select those in whom adjuvant treatment is necessary. ' 2007 Wiley-Liss, Inc.

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Radical Extensive Surgery for Renal Cell Carcinoma: Long-Term Results and Prognostic Factors

Cited by 272 publications

References 30 publications

The Relationship of Fuhrman Nuclear Grade, Tumor Stage and Sarcomatoid Differentiation with Survival in Renal Cell Carcinomas

The Relationship of Fuhrman Nuclear Grade, Tumor Stage and Sarcomatoid Differentiation with Survival in Renal Cell Carcinomas

Advances and controversies in grading and staging of renal cell carcinoma

Patients with renal cell carcinoma nodal metastases can be accurately identified: External validation of a new nomogram

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