Microvascular Tumor Invasion: Prognostic Significance in Low-Stage Renal Cell Carcinoma

Madbouly, Khaled; AlQahtani, Saeed M; Ghazwani, Yahia; Al-Shaibani, Saeed; Mansi, Mostafa K.

doi:10.1016/j.urology.2007.01.012

Cited by 32 publications

(18 citation statements)

References 19 publications

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“…In a small series of mixed histology T1 and T2 tumors, microvascular invasion was shown to correlate with outcome and this was found to be independent of T category, grade and perirenal fat invasion. 94 In earlier studies the presence of microvascular invasion of the renal vein was also found to be associated with a significantly higher rate of tumor recurrence following nephrectomy. 95,96 Microvascular invasion has also been shown to correlate with the development of metastases and with survival, independent of tumor size, primary tumor category-pT1 to pT3, and Fuhrman grade.…”

Section: Regional Spread Of Tumor (Tnm Category T3)mentioning

confidence: 88%

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: Regional Spread Of Tumor (Tnm Category T3)mentioning

confidence: 88%

Advances and controversies in grading and staging of renal cell carcinoma

2009

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“…In a series of T1 and T2 tumours intrarenal microvascular invasion has been shown to be of prognostic significance independent of pT category, grade and perineural fat invasion 40. Despite this, lymphovascular invasion is not a feature of UICC TNM staging, although it was widely recognised to be an important prognostic parameter by participants in the survey.…”

Section: Discussionmentioning

confidence: 99%

Handling and reporting of nephrectomy specimens for adult renal tumours: a survey by the European Network of Uropathology

et al. 2011

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AimTo collect information on current practices of European pathologists for the handling and reporting of nephrectomy specimens with renal tumours. Methods and Results A questionnaire was circulated to the members of the European Network of Uropathology, which consists of 343 pathologists in 15 European countries. Replies were received from 48% of members. These replies indicated that nephrectomy specimens are most often received in formalin. Lymph nodes are found in less than 5% of nephrectomy specimens. All respondents give an objective measure of tumour size, most commonly in three diameters. The most common method to search for capsule penetration is to slice tissue outside the tumour perpendicularly into the tumour. The most common sampling algorithm from tumours greater than 2 cm is one section for every centimetre of maximum tumour diameter. Most respondents use the 2004 WHO renal tumour classification although only slightly over half consider small papillary tumours malignant if the diameter is greater than 5 mm. The Fuhrman grading system is widely used. Almost all use immunohistochemistry for histological typing in some cases, while only 7% always use it. The most utilised special stains are CK7 (95%), CD10 (93%), vimentin (86%), HMB45 (68%), c-kit (61%) and Hale's colloidal iron (52%). Only 18% use other ancillary techniques for diagnosis in difficult cases. Conclusions While most pathologists appear to follow published guidelines for reporting renal carcinoma, there is still a need for the development of consensus and further standardisation of practice for contentious areas of specimen handling and reporting.The second edition of the WHO classification of renal tumours, published in 1981, divided carcinomas of the renal parenchyma into two categoriesdrenal cell carcinoma and other.1 At that time, there were limited treatment options for these tumours and as there were few validated prognostic factors, histological reports were somewhat basic. In recent years there has been an enormous expansion in our understanding of the histogenesis, morphology and molecular biology of these tumours, and it is now recognised that renal cell carcinoma is not a single entity but a diverse group of tumours with differing morphology, genetics and clinical course.

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“…La existencia de invasión microscópica se muestra como un factor pronóstico independiente desfavorable 21,[24][25][26][27] . Posee un pronunciado efecto negativo sobre el periodo libre de recurrencia, incluso en los pacientes con estadios bajos, pudiendo, en estos casos, descender la supervivencia a los cinco años desde el 90% de aquellos que no la presentan hasta el 45% de los que la poseen.…”

Section: Afectación Vascularunclassified

“…En relación al desarrollo de metástasis, un 50% de los afectados por invasión microvascular las desarrolla frente al 5% de los casos con ausencia de la misma 27 .…”

Section: Afectación Vascularunclassified

Factores pronósticos del carcinoma de células renales

et al. 2009

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E l diagnóstico del cáncer renal ha aumentado en las últimas décadas debido a diferentes motivos, entre ellos al avance en las técnicas diagnósticas. En este sentido, la estimación realizada por la Agencia Internacional de Investigación del Cáncer (IARC) para la prevalencia del cáncer de riñón en nuestro país fue de 2.977 casos en 1 año, 8.273 casos en 3 años y 12.079 casos en 5 años. La incidencia/100.000 habitantes se situaría en 13,97 para los hombres y 4,83 para las mujeres en el periodo 1997-2000, según el análisis publicado por el Ministerio de Sanidad en el año 2005 1 . La tasa cruda de mortalidad/100.000 habitantes se sitúa en 5,7 para los hombres y 2,9 para las mujeres.El estudio EROCARE-4, desarrollado en Europa y publicado recientemente, muestra una supervivencia global a los 5 años del 59,2% 2 .Otro aspecto a destacar es el hecho de que el 30% de estos tumores son metastáticos a su diagnóstico 3 , y que los pacientes sometidos a tratamiento quirúrgi-co en estadios localizados el 30% desarrollarán metás-tasis a lo largo de su evolución. A esto hay que sumar la diversidad morfológica de las neoplasias renales, llegando a plantearse la existencia de una gran variedad de entidades bajo el concepto de carcinoma renal (CR), con un comportamiento biológico diferente cada una de ellas, y con base citogenética individual 4 .En este sentido, podemos decir que en nuestros días se priorizan tres líneas de actuación en el CR 5 :-Detección en estadios precoces.-Desarrollo de terapias sistémicas más efectivas para la enfermedad metastásica. -Identificación de nuevos marcadores que aporten información sobre el pronóstico y respuesta a los diferentes tratamientos. ResumenEl diagnóstico del cáncer renal ha aumentado en las últimas décadas. A esto hay que sumar la diversidad morfológica de las neoplasias renales, llegando a plantearse la existencia de una gran variedad de entidades bajo el concepto de carcinoma renal (CR). El estudio EROCARE-4, publicado recientemente, muestra una supervivencia global a los 5 años del 59,2%. En este contexto, y como ocurre en toda patología oncológica, la determinación adecuada de factores pronósticos ayudaría a plantear la estrategia terapéutica más apropiada en cada caso, dirigir futuros tratamientos y desarrollar esquemas específicos de seguimiento para nuestros pacientes. En la actualidad los diferentes factores pronósticos de CR podemos clasificarlos en cuatro grupos: anatómicos, clínicos, histológicos y moleculares. En este trabajo analizamos estos factores pronósticos y revisamos los nomogramas más extendidos en la actualidad.Palabras clave: Carcinoma de células renales. Factores pronósticos. Supervivencia. Prognostic factors in renal cell carcinoma AbstractRenal cancer has been increasingly diagnosed in recent decades. In addition, morphological diversity of renal neoplasms has led to consider that the concept of renal cell (RC) carcinoma encompasses a wide variety of conditions. The recently publshed EROCARE-4 study showed a 5-year overall survival rate of 59.2%. In this and ...

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Microvascular Tumor Invasion: Prognostic Significance in Low-Stage Renal Cell Carcinoma

Cited by 32 publications

References 19 publications

Advances and controversies in grading and staging of renal cell carcinoma

Advances and controversies in grading and staging of renal cell carcinoma

Handling and reporting of nephrectomy specimens for adult renal tumours: a survey by the European Network of Uropathology

Factores pronósticos del carcinoma de células renales

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