The Impact of a 4 Cm. Cutoff Point for Stratification of T1n0m0 Renal Cell Carcinoma After Radical Nephrectomy

Igarashi, Tatsuo; Tobe, Toyofusa; Nakatsu, Hiroomi; Suzuki, Noriyuki; Murakami, Shino; Hamano, Masaaki; Maruoka, Masayuki; Nagayama, Tadao; Matsuzaki, Osamu; Itô, Haruo

doi:10.1097/00005392-200104000-00010

Cited by 14 publications

(24 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several authors [3,4] have indicated that in terms of prognosis, grouping tumours that vary so broadly in size under a single stage classification does not change cancer-specific survival. However, in accordance with other authors (table 2) [5][6][7][8][9][10] who have proposed a re-evaluation of the 1997 TNM classification using different cut-offs (ranging between 4 and 5.5 cm) that correlated better with clinical outcome than 7 cm, we deciced to review our experience in this regard. We also performed this study in order to determine if there were any differences in terms of cancer-specific survival by dividing stage pT1 into two different groups employing different cut-off point sizes of 0.5 cm (from 2.5 to 5 cm); however, there was a slight statistical significance only for a cut-off of 5 cm (p = 0.2844).…”

Section: Discussionsupporting

confidence: 68%

Stage pT1 Renal Cell Carcinoma: Review of the Prognostic Significance of Size

Zucchi

Mearini²,

Mearini³

et al. 2003

Urol Int

View full text Add to dashboard Cite

Introduction: The last TNM classification (before 1997) defined T1 kidney tumour as a tumour <2.5 cm, limited to the kidney: this cut-off point was changed in 1997 and T1 neoplasm was defined as <7 cm. This new cut-off now includes past T1 and T2 diseases, without any differences in terms of prognoses. We performed a retrospective analysis of our cases and specifically investigated if there were any differences in terms of prognosis in a group of patients, currently identifiable as pT1, if they were divided into two subgroups based on tumour pathological sizes. Materials and Methods: Our analysis involved 128 patients (mean age 57.6 years) who underwent radical nephrectomy or nephron-sparing surgery in the period between 1990 and 2000. All these patients were pT1 according to the new TNM classification and were divided into two groups according to different cut-off point sizes (from 2.5 to 5 cm). We analysed the surgical approach, overall survival and cancer-specific mortality in the two subgroups, renamed as pT1a and pT1b, and performed a statistical analysis of the results using the Kaplan-Meier method to prove if this substaging identified changes in survival outcome. Results: We obtained more interesting results for a 5-cm cut-off: the two groups showed a similar follow-up and overall survival rate but different cancer-specific mortality rate (6 vs. 12.1%). The statistical analysis showed that the two survival curves (pT1a vs. pT1b disease) had a similar trend up to about 60 months; after this period the two curves diversify with a drop in survival rate among patients with larger tumours (pT1b patients). Conclusions: It would seem reasonable to reassess the TNM classification of stage pT1 in order to better define prognosis in this group of patients.

show abstract

Section: Discussionsupporting

confidence: 68%

Stage pT1 Renal Cell Carcinoma: Review of the Prognostic Significance of Size

Zucchi

Mearini²,

Mearini³

et al. 2003

Urol Int

View full text Add to dashboard Cite

show abstract

“…Krejci et al 8 correlated tumor size with cause-specific survival and proposed a 5.0-cm size cutoff to separate T1a and T1b tumors. Igarashi et al 11 reviewed 333 patients with 1997 T1N0M0 RCC. They proposed a cutoff size of 4.0 cm for dividing T1 tumors into T1a and T1b subclasses because this cutoff maximized the difference in disease-free survival.…”

Section: Discussionmentioning

confidence: 99%

Reassessment of the 1997 TNM classification system for renal cell carcinoma

Elmore

Kadesky

Koeneman

et al. 2003

Cancer

View full text Add to dashboard Cite

BACKGROUNDThe 1997 TNM staging classification for renal cell carcinoma (RCC) defined Stage I tumors as organ‐confined tumors measuring up to 7 cm in size. The authors evaluated the validity of this cutoff size by assessing the survival of patients with Stage I RCC according to a series of alternative size cutoff values. In addition, the authors determined how these size cutoffs affected the risk of having nonorgan‐confined tumors, regional lymph node involvement, and metastatic disease.METHODSA database containing the records of 1324 patients with RCC who underwent open radical nephrectomy between 1960 and 1991 was evaluated. Patients with Stage I disease were stratified by size cutoffs ranging from 2.5 to 7.0 cm in 0.5‐cm increments. Five‐year disease‐specific survival (DSS) rates were estimated using the Kaplan–Meier method. The log‐rank test was used to compare survival curves. The survival of patients with tumors smaller than a specified size cutoff was compared with the survival of patients with tumors larger than that cutoff and the most discriminating cutoff was identified. The same size cutoffs were used to compare the incidence of local nonorgan‐confined, lymph node‐positive, and metastatic disease for all patients with tumors 7.0 cm or smaller.RESULTSOf 544 evaluable patients, 351 patients had tumors 7.0 cm or smaller and 233 of these patients had 1997 Stage I (T1N0M0) disease. When patients with 1997 Stage I tumors were separated using the various size cutoffs, survivals were most different using a 5.0‐cm cutoff. The 5‐year DSS rates for patients with Stage I tumors 5 cm or smaller versus those with tumors measuring 5.1–7 cm were 94.6% versus 79.2% (P = 0.003). Furthermore, the survival of patients with Stage I RCC lesions measuring 5.1–7.0 cm was the same as for patients with 1997 Stage II (T2N0M0) RCC. The difference in probability of having local nonorgan‐confined disease was also greatest with a 5.0 cm cutoff value. Nonorgan‐ confined disease was reported to be present in 16.2% of the patients with tumors smaller than 5.0 cm compared with 36.8% of the patients with tumors measuring 5.1–7.0 cm in size. The difference in the probabilities of having lymph node‐positive or metastatic disease did not change significantly using any of the cutoffs, although the probability of both of these increased with increasing tumor size.CONCLUSIONSSurvival and disease recurrence analysis in a large group of patients with RCC who underwent radical nephrectomy showed that the 1997 TNM cutoff of 7.0 cm used to separate Stage I from Stage II disease was too high. A size‐related survival difference was found among patients with organ‐confined 1997 Stage I disease and a 5.0‐cm cutoff best stratified this difference. This finding was in general agreement with the changes made in the 6th edition of the American Joint Committee on Cancer cancer staging manual. Patients with tumors measuring between 5.1 cm and 7.0 cm were found to have the same survival as patients with Stage II disease. Thus, subclassification of T1 into T1a and T1b, as in the 6th edition of the AJCC cancer staging manual, may not be optimal. The 5‐cm cutoff also best stratified the risk of developing nonorgan‐confined disease. This finding may have an impact on nephron‐sparing surgery in selected patients. The findings of the current study, as well as those of others, supported an upper size cutoff of 4–5 cm for patients with Stage I RCC. Cancer 2003. © 2003 American Cancer Society.

show abstract

“…Existe uma nova corrente propondo ponto de corte em 4 cm e a modificação do atual estádio T1 (TNM 97) para T1a e T1b [7][8][9] , que seria melhor para predizer sobrevida câncer específica e livre de doença otimizando o prognóstico 9 . Nós aderimos a este grupo, pois pacientes com tumores inferiores a 4 cm poderiam prescindir do seguimento pós-operatório, se confirmados critérios de bom prognóstico, como já foi proposto anteriormente 21 .…”

Section: Discussionunclassified

“…Nós aderimos a este grupo, pois pacientes com tumores inferiores a 4 cm poderiam prescindir do seguimento pós-operatório, se confirmados critérios de bom prognóstico, como já foi proposto anteriormente 21 . Como os tumores menores de 4 cm raramente apresentam características de mau prognóstico e o estudo do grau nuclear e invasão microvascular exigem análise multivariada, ao passo que o tamanho tumoral já pode ser mensurado antes da cirurgia e tem valor progóstico 9 , o ponto de corte de 4 cm servirá para otimizar as relações entre tamanho tumoral e os outros caracteres de mau prognóstico. A sobrevida em cinco anos para tumores de alto grau é de 46% 26 e gânglios comprometidos equivalente a 33% 2 , já a presença de invasão microvascular intratumoral confere chance de progressão da doença em 39% dos casos 27 e a degeneração sarcomatosa proporciona sobrevida média de 49 meses aos PT1 e 6,8 meses aos demais estádios da doença 26 .…”

Section: Discussionunclassified

See 1 more Smart Citation

O estadiamento TNM do carcinoma de células renais deve ser modificado novamente ?

Dall’Oglio¹,

Srougi²,

Nesrallah³

et al. 2003

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

RESUMO -OBJETIVOS. O comportamento do carcinoma de células, porém já existem propostas para modificá-lo novamente 7,8,9 . Estudos atuais relatam excelentes resultados com cirurgia conservadora 10 , no entanto a maioria não compara a sobrevida entre os pacientes com tamanhos tumorais distintos.Nós, retrospectivamente, avaliamos o tamanho tumoral e a presença de fatores prognósticos na recorrência e sobrevida dos pacientes com CCR com objetivo de rediscutir o ponto de corte do atual T1(TNM-1997), julgando que existe uma diferença substancial no prognóstico dos tumores a partir de 4 cm de diâmetro. MÉTODOSNo período entre janeiro de 1988 e julho de 1999, 128 pacientes com CCR foram operados por um mesmo grupo de cirurgiões nos Hospitais Sírio Libanês e Beneficência Portuguesa de São Paulo sendo avaliados retrospectivamente. A avaliação pré-operatória compreendeu exames hematológicos e exames de imagem como a ultra-sonografia (US), tomografia computadorizada (TC) e/ou ressonância nuclear magnética, urografia excretora, cinti- lografia óssea e radiografia de tórax. O seguimento pós-operatório variou entre 2 e 138 meses (mediano: 33 meses). Os pacientes foram consultados sobre a participação no estudo através de carta informativa e termo de consentimento pós-informação e posteriormente foi feita análise retrospectiva através dos dados de prontuário. Destes, foram excluídos oito pacientes porque tinham material anatomopatológico insuficiente para revisão ou este era inconclusivo.As informações clínicas resgatadas destes prontuários incluíram idade, sexo, rim acometido, data do diagnóstico, apresentação clínica inicial, propedêutica, histórias pregressas, antecedentes pessoais e familiares, terapia cirúrgica realizada (radical ou conservadora), laudo anatomopatológico e seguimento pós-operatório.Todo material anatomopatológico (lâ-minas coradas com H.E e fragmentos blocados em parafina) foi revisado ao microscópio ótico por um único patologista. O acompanhamento pós-operatório foi realizado no consultório e quando a última consulta se deu há mais de três meses houve

show abstract

The Impact of a 4 Cm. Cutoff Point for Stratification of T1n0m0 Renal Cell Carcinoma After Radical Nephrectomy

Abstract: Tumor size is an important prognostic factor for patients with T1N0M0 renal cell carcinoma. A cutoff point of 4 cm. is practical for dividing the T1N0M0 classification into T1a and T1b subclasses.

Cited by 14 publications

References 15 publications

Stage pT1 Renal Cell Carcinoma: Review of the Prognostic Significance of Size

Stage pT1 Renal Cell Carcinoma: Review of the Prognostic Significance of Size

Reassessment of the 1997 TNM classification system for renal cell carcinoma

O estadiamento TNM do carcinoma de células renais deve ser modificado novamente ?

Contact Info

Product

Resources

About