Renal cell carcinoma with isolated lymph node metastases should be reclassified as stage IV

Shapiro, Daniel D.; Abel, E. Jason

doi:10.1002/cncr.32913

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…In all, 204 patients with sRCC and 217 with Grade 4 non-sRCC had recurrence data available. The median (95% CI) RFS between sRCC and non-sRCC was 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) months compared to 23 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) months, respectively (P = 0.059; Fig. 1).…”

Section: Resultsmentioning

confidence: 97%

“…Most importantly, if our localised sarcomatoid survival results are confirmed, amending current staging systems to better represent the poor prognostic presence of sRCC is reasonable. Indeed, this is not the first time traditional TNM staging has been questioned [23,24]. In 2007, criticism was rendered of then-current 2002 AJCC staging guidelines for locally advanced RCC as it failed to incorporate 'alternative clinicopathologic factors important in RCC prognosis' such as histological subtype, presence of necrosis and, interestingly, sarcomatoid features [24].…”

Section: Discussionmentioning

confidence: 99%

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Localised non‐metastatic sarcomatoid renal cell carcinoma: a 31‐year externally verified study

Blum,

Silagy,

Knezevic

et al. 2023

BJU International

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Abstract:ObjectivesMost sRCC research focuses on advanced or metastatic disease, with limited studies analyzing localized non‐metastatic patient outcomes. This study evaluates post‐nephrectomy outcomes and predictors of cancer‐specific survival (CSS) between localized sRCC and grade‐4 RCC (non‐sRCC) patients.Materials and Methods564 localized RCC patients underwent partial or radical nephrectomy between June 1988 to March 2019 for sRCC (n=204) or WHO/ISUP grade‐4 non‐sRCC (n=360). CSS at every stage between groups were assessed. Phase‐III ASSURE clinical trial data was used to externally validate CSS findings. Man‐Whitney U, Chi‐squared tests compared outcomes and Kaplan‐Meier method evaluated CSS, overall survival (OS) and recurrence‐free survival. Clinicopathologic features associated with RCC death were evaluated using Cox‐proportional hazards regression.ResultsMedian follow‐up was 31.5 months. Median OS and CSS between sRCC and grade‐4 non‐sRCC groups was 45 vs 102 months and 49 vs 152 months, respectively, p<0.001. At every stage, sRCC had worse CSS compared to grade‐4 non‐sRCC. Notably, pT1 sRCC had worse CSS than pT3 grade‐4 non‐sRCC. Negative predictors of CSS were sarcomatoid features, non‐clear cell histology, positive‐margins, higher stage (pT3/pT4) and use of minimally‐invasive surgery (MIS). ASSURE external verification showed worse CSS in sRCC patients (HR 1.63 (95% CI [1.12‐2.36]), p=0.01), but not worse outcomes in MIS surgery (HR 1.39 (95% CI [0.75‐2.56]), p=0.30).ConclusionsLocalized sRCC has worse CSS compared to grade‐4 non‐sRCC at every stage. Negative survival predictors included positive‐margins, higher pathological stage, use of MIS, and non‐ccRCC histology. sRCC is an aggressive variant even at low stages requiring vigilant surveillance and possible inclusion in adjuvant therapy trials.

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Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Localised non‐metastatic sarcomatoid renal cell carcinoma: a 31‐year externally verified study

Blum,

Silagy,

Knezevic

et al. 2023

BJU International

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“…[79] Daniel et al suggested the reclassification of RCC with isolated LN metastases to stage IV to enable more precise baseline risk stratification for patients with LNM-RCC. [80] Given the current lack of robust and consistent evidence from retrospective studies on LND, further research is imperative to evaluate the efficacy of LND and to improve the stratification of patients, identifying those who may derive benefit from the intervention.…”

Section: The Site Of Rcc Metastasismentioning

confidence: 99%

Therapeutic options for different metastatic sites arising from renal cell carcinoma: A review

Wang,

Qian,

Qian

et al. 2024

Medicine

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Renal cell carcinoma (RCC) stands among the top 10 malignant neoplasms with the highest fatality rates. It exhibits pronounced heterogeneity and robust metastatic behavior. Patients with RCC may present with solitary or multiple metastatic lesions at various anatomical sites, and their prognoses are contingent upon the site of metastasis. When deliberating the optimal therapeutic approach for a patient, thorough evaluation of significant risk factors such as the feasibility of complete resection, the presence of oligometastases, and the patient’s functional and physical condition is imperative. Recognizing the nuanced differences in RCC metastasis to distinct organs proves advantageous in contemplating potential treatment modalities aimed at optimizing survival outcomes. Moreover, discerning the metastatic site holds promise for enhancing risk stratification in individuals with metastatic RCC. This review summarizes the recent data pertaining to the current status of different RCC metastatic sites and elucidates their role in informing clinical management strategies across diverse metastatic locales of RCC.

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Re: Wesley Yip, Alireza Ghoreifi, Thomas Gerald, et al. Perioperative Complications and Oncologic Outcomes of Nephrectomy Following Immune Checkpoint Inhibitor Therapy: A Multicenter Collaborative Study. Eur Urol Oncol. Eur Urol. Onc. 2023;604–610

Shapiro

Karam

Master

et al. 2023

European Urology Oncology

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Renal cell carcinoma with isolated lymph node metastases should be reclassified as stage IV

Cited by 4 publications

References 21 publications

Localised non‐metastatic sarcomatoid renal cell carcinoma: a 31‐year externally verified study

Localised non‐metastatic sarcomatoid renal cell carcinoma: a 31‐year externally verified study

Therapeutic options for different metastatic sites arising from renal cell carcinoma: A review

Re: Wesley Yip, Alireza Ghoreifi, Thomas Gerald, et al. Perioperative Complications and Oncologic Outcomes of Nephrectomy Following Immune Checkpoint Inhibitor Therapy: A Multicenter Collaborative Study. Eur Urol Oncol. Eur Urol. Onc. 2023;604–610

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