Reassessing the Current TNM Lymph Node Staging for Renal Cell Carcinoma

Terrone, Carlo; Cracco, Cecilia Maria; Porpiglia, Francesco; Bollito, Enrico; Scoffone, Cesare Marco; Poggio, M.; Berruti, Alfredo; Ragni, F.; Cossu, M.; Scarpa, R.M.; Rossétti, S. Rocca

doi:10.1016/j.eururo.2005.11.014

Cited by 90 publications

(39 citation statements)

References 20 publications

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“…111 In validation studies of the N category of the 2002 TNM classification, it was found that there was no difference in the survival rate of pN1 and pN2 tumors at 5 years follow-up (20 and 17%, respectively). 112 When cases were divided at r4 and 44 involved nodes, the difference in survival between the two groups was significant. It was also shown that survival decreased with an increase in the percentage of involved nodes in each case, with significance being achieved at a cut point of 60%.…”

Section: Lymph Node Metastasesmentioning

confidence: 95%

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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Section: Lymph Node Metastasesmentioning

confidence: 95%

Advances and controversies in grading and staging of renal cell carcinoma

2009

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“…Fuhrman grades were dichotomized between low 1,2 and high. 3,4 This Fuhrman classification results in the most sparse use of the degrees of freedom and maximizes the efficiency of statistical analyses. 9 …”

Section: Patient Populationmentioning

confidence: 99%

“…The TNM system [1][2][3] assigns the stage and indicates the prognosis according to the characteristics of the primary tumor for patients without lymph node or distant metastases. Conversely, the N category stratifies the prognosis in patients who have established lymph node metastases but not distant disease.…”

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confidence: 99%

Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma

Lughezzani

Capitanio

Jeldres

et al. 2009

Cancer

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BACKGROUND: Virtually all staging schemes aimed at predicting the prognosis of surgically treated patients diagnosed with metastatic renal cell carcinoma (MRCC) omit the use of lymph node stage. In the current study, the authors tested the prognostic significance of lymph node stage in patients with MRCC within a population‐based cohort of patients treated with cytoreductive nephrectomy to assess whether the inclusion of lymph node stage could improve the accuracy of cancer‐specific mortality predictions. METHODS: Within the Surveillance, Epidemiology, and End Results database, the authors identified 1153 patients who were treated with cytoreductive nephrectomy for MRCC, with (negative lymph nodes [N0] vs positive lymph nodes [N1‐2]) or without (unknown lymph node stage [Nx]) lymphadenectomy. Of 797 patients treated with lymphadenectomy, 42.9% were found to have lymph node metastases. Kaplan‐Meier plots and univariate and multivariate Cox regression analyses tested the statistical significance and the independent predictor status of lymph node stage, Fuhrman grade, tumor size, year of surgery, race, sex, and age in patients who underwent lymphadenectomy at the time of cytoreductive nephrectomy. RESULTS: At 3 years after cytoreductive nephrectomy, the cancer‐specific mortality‐free rates of N1‐2 versus N0 versus Nx patients were 14.4% versus 34.7% versus 34.0%, respectively. Lymph node stage represented the most informative variable and achieved independent predictor status in all multivariate models (P < .001). Consideration of lymph node stage added 3.2% accuracy to other predictors of cancer‐specific mortality. CONCLUSIONS: The findings of the current study indicate that lymph node stage should be considered in prognostic models. The TNM staging of MRCC patients also should rely on the stage of locoregional lymph nodes, because the 3‐year cancer‐specific mortality rates of lymph node‐negative and lymph node‐positive MRCC patients differ by as much as 20%. Cancer 2009. © 2009 American Cancer Society.

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“…Almost all available mathematical models use the 1997 version of the TNM staging system that is very similar to the more recent 2002 version [32] . Nevertheless, it is possible to hypothesize that the forthcoming TNM version will satisfy some of the proposals for reclassification of organ-confined (T1-2), locally advanced (T3-4), and lymph node involving (N1-2) tumors published in the last years [33][34][35][36] .…”

Section: Discussionmentioning

confidence: 99%

Mathematical Models for Prognostic Prediction in Patients with Renal Cell Carcinoma

et al. 2008

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Objectives: The objectives of this study are to catalogue all models developed to predict survival of RCC patients and to identify the ones to be used in different situations. Methods: A systematic review was performed searching with a free text and MeSH strategy 3 electronic databases. For each model, the following parameters were identified: number, features of the patients; evaluation endpoints; clinical and/or pathological variables included; concordance indexes (cI). Results: The research retrieved 156 records. Eleven articles proposed new models, 5 articles external validations. We retrieved 2 mathematical models including clinical variables only (Yaycioglu, cI 0.651; Cindolo, cI 0.672); 2 algorithms including also pathological variables (SSIGN, cI 0.819; UISS, cI 0.79–0.84), 5 nomograms (Kattan, cI 0.76–0.86; Sorbellini, cI 0.82; Kim 2004, cI 0.79, Kim 2005, cI 0.68; Karakiewicz, cI 0.86); 2 algorithms for patients with metastatic disease (Motzer, Leibovich). Conclusions: The SSIGN was the most accurate algorithm for conventional RCC, while the UISS allowed the evaluation of patients regardless of tumor histotype. The Sorbellini nomogram is applicable only for patients with conventional RCC, while the Kattan and Karakiewicz nomograms also provide information for other histotypes. Metastatic patients can be evaluated with Leibovich and Motzer algorithms. Two models combine molecular markers and clinical features (Kim 2004–2005).

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Reassessing the Current TNM Lymph Node Staging for Renal Cell Carcinoma

Cited by 90 publications

References 20 publications

Advances and controversies in grading and staging of renal cell carcinoma

Advances and controversies in grading and staging of renal cell carcinoma

Prognostic significance of lymph node invasion in patients with metastatic renal cell carcinoma

Mathematical Models for Prognostic Prediction in Patients with Renal Cell Carcinoma

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