Nephron Sparing Surgery for Localized Renal Cell Carcinoma: Impact of Tumor Size on Patient Survival, Tumor Recurrence and TNM Staging

Hafez, Khaled S.; Fergany, Amr; Novick, Andrew C.

doi:10.1016/s0022-5347(05)68071-8

Cited by 546 publications

(260 citation statements)

References 6 publications

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“…42,[76][77][78][79][80] These findings are not surprising as detailed analysis of tumor size as a continuous variable has shown that the probability of death increases with tumor size (3.51 Â for each doubling of tumor size). 81 As a consequence any arbitrary cut point will likely be significantly associated with survival providing that the sample size is sufficiently large.…”

Section: Tumor Size (Tnm Categories T1 and T2)mentioning

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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Section: Tumor Size (Tnm Categories T1 and T2)mentioning

confidence: 99%

Advances and controversies in grading and staging of renal cell carcinoma

2009

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“…We collapsed tumor size into 2 clinically relevant groups based on a 4-cm threshold. 14 We assigned median Census-tract income and Censustract percentage of nonhigh school graduates as patient-level measures of income and education, respectively. 25 We measured pre-existing comorbidity by using a modification of the Charlson Index 26 to identify comorbid conditions (including diabetes, renal insufficiency, and cardiovascular disease) from inpatient and physician claims that were submitted during the 12 months before the index admission for kidney cancer surgery.…”

Section: Patient-level Covariatesmentioning

confidence: 99%

“…1,2,4,11,12 In synchronicity with the gradual dissemination of laparoscopic radical nephrectomy, 2,4 multiple investigators reported that, for selected patients with smaller renal tumors, partial nephrectomy yields oncologic outcomes that are indistinguishable from the outcomes achieved by radical excision. [13][14][15] Partial nephrectomy also preserves long-term renal function 16,17 while reducing over-treatment of patients with benign 18 or clinically indolent 19 tumors.…”

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confidence: 99%

Diffusion of surgical innovation among patients with kidney cancer

Miller

Saigal

Banerjee

et al. 2008

Cancer

107

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BACKGROUNDDespite their potential benefits to patients with kidney cancer, the adoption of partial nephrectomy and laparoscopy has been gradual and asymmetric. To clarify whether this trend reflects differences in kidney cancer patients or differences in surgeon practice styles, the authors compared the magnitude of surgeon‐attributable variance in the use of partial nephrectomy and laparoscopic radical nephrectomy with that attributable to patient and tumor characteristics.METHODSBy using linked Surveillance, Epidemiology, and End Results‐Medicare data, the authors identified a cohort of 5483 Medicare beneficiaries who underwent surgery for kidney cancer between 1997 and 2002. Two primary outcomes were defined: 1) the use of partial nephrectomy and (2) the use of laparoscopy among patients undergoing radical nephrectomy. By using multilevel models, surgeon‐ and patient‐level contributions to observed variations in the use of partial nephrectomy and laparoscopic radical nephrectomy were estimated.RESULTSOf the 5483 cases identified, 611 (11.1%) underwent partial nephrectomy (43 performed laparoscopically), and 4872 (88.9%) underwent radical nephrectomy (515 performed laparoscopically). After adjusting for patient demographics, comorbidity, tumor size, and surgeon volume, the surgeon‐attributable variance was 18.1% for partial nephrectomy and 37.4% for laparoscopy. For both outcomes, the percentage of total variance attributable to surgeon factors was consistently higher than that attributable to patient characteristics.CONCLUSIONSFor many patients with kidney cancer, the surgery provided depends more on their surgeon's practice style than on the characteristics of the patient and his or her disease. Consequently, dismantling barriers to surgeon adoption of partial nephrectomy and laparoscopy is an important step toward improving the quality of care for patients with early‐stage kidney cancer. Cancer 2008. © 2008 American Cancer Society.

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“…This information suggests that tumor growth significantly influences the prognosis of this lethal disease. The majority of studies that have reported a large number of patients indicate that the stratification size related to RCC prognosis is between 4 and 5 cm (3,4).…”

Section: Clinical Urolog� Clinical Urolog� Doi: 101590/s1677-5538201mentioning

confidence: 99%

The beginning of the 21st century: a paradigm shift in the surgical management of renal cell carcinoma in South America

Dall’Oglio

Crippa²,

Câmara³

et al. 2010

Int. braz j urol.

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Purpose: The incidence of renal cell carcinoma (RCC) has been rising by 2.3 to 4.3% every year over the past three decades. Previously, RCC has been known as the internist's tumor; however, it is now being called the radiologist's tumor because 2/3 are now detected incidentally on abdominal imaging. We compared patients who were treated toward the end of the 20th century to those treated during the beginning of the 21st century with regard to RCC size and type of surgical treatment. Materials and Methods:The study included 226 patients. For analysis of tumor size, we considered a cut point of < 4 cm and > 4 cm. For analysis of type of surgery performed, we considered radical and partial nephrectomy. Results: After the turn of the century, there was a reduction of 1.57 ± 0.48 cm in the size of the RCC that was operated on. Nephron sparing surgeries were performed in 17% of the cases until the year 2000, and 39% of the tumors were < 4 cm. From 2001, 64% of the tumors measured < 4 cm and 42% of the surgeries were performed using nephron sparing techniques. Mean tumor size was 5.95 cm (± 3.58) for the cases diagnosed before year 2000, and cases treated after the beginning of 21st century had a mean tumor size of 4.38 cm (± 3.27). Conclusions: Compared with the end of the 20th century, at the beginning of the 21st century due to a reduction in tumor size it was possible to increase the number of nephron sparing surgeries.

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Nephron Sparing Surgery for Localized Renal Cell Carcinoma: Impact of Tumor Size on Patient Survival, Tumor Recurrence and TNM Staging

Cited by 546 publications

References 6 publications

Advances and controversies in grading and staging of renal cell carcinoma

Advances and controversies in grading and staging of renal cell carcinoma

Diffusion of surgical innovation among patients with kidney cancer

The beginning of the 21st century: a paradigm shift in the surgical management of renal cell carcinoma in South America

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