Re‐evaluation of the Tumour‐Node‐Metastasis staging of locally advanced renal cortical tumours: absolute size (T2) is more significant than renal capsular invasion (T3a)

Abstract

OBJECTIVETo determine which factor was more predictive of adverse outcome in our institutional experience with T2N0M0 and T3N0M0 renal cortical tumours (RCTs) treated surgically, as the current TumourNode-Metastasis (TNM) staging system for RCTs differentiates between tumours of > 7.0 cm but confined to the renal capsule (T2) and tumours that extend through the renal capsule regardless of size (T3a). MATERIALS AND METHODSWe analysed our institutional database of surgical urological oncology for all patients with T2N0M0 and T3aN0M0 RCT treated with partial or radical nephrectomy from 1988 to 2002. All patients with preoperative metastasis, bilateral or multifocal tumours, nonsporadic disease or benign histology were excluded from analysis. A follow-up of ≥ 6 months from the time of surgery was required for inclusion. Primary outcomes included local and distant recurrence, and death. RESULTSIn all, 717 patients had a partial or radical nephrectomy for RCT during the study period. After exclusion criteria were applied, 21 patients with T2N0M0 and 97 with T3aN0M0 tumours were eligible; the median (mean, range) age was 63 (16.6-88.3) years and follow-up 30.5 (40.8, 6-162) months. The estimated 5-year disease-free survival was 68% and 85% for T2N0M0 and T3aN0M0 RCT, respectively ( P = 0.002). The 5-year diseasespecific survival was 81% and 94% for the T2N0M0 and T3aN0M0 groups, respectively ( P = 0.085). CONCLUSIONPatients with T3aN0M0 tumours appear to have better disease-free and disease-specific survival than those with T2N0M0 disease, which suggests that tumour invasion through the renal capsule is not as significant as the absolute tumour size.Authors from Iowa City report on the incidence of RCC; they compared the rate of these tumours at autopsy and felt that the decrease found was a result of better antemortem detection, and an increase with time in the frequency of clinically detected renal cancer.

Use of the University of California Los Angeles Integrated Staging System (UISS) to predict survival in localized renal cell carcinoma in an Asian population

“…Therefore, this cultural effect may account for the relative low staging disease (5 patients, 50%, were T3a) in our HR group and also relative low T4 disease in our population. There were several reports suggesting that pT3a disease may have a better prognosis than pT2 disease, unless its size was greater than 7 cm [6,22,23]. Therefore, the higher proportion of T3a disease in our HR group may also partly explain the observed better survival rate of our patients, which was even better than our IR group.…”

Reappraisal of T3N0/NxM0 renal cell carcinoma: significance of extent of fat invasion, renal vein invasion, and adrenal invasion

“…Murphy et al [12] compared T2 tumors to T3a tumors and found that the risk of metastasis was equivalent in both but that the T2 tumors actually demonstrated a worse disease-free survival.…”

Tumor size and Fuhrman grade further enhance the prognostic impact of perinephric fat invasion and renal vein extension in T3a staging of renal cell carcinoma

“…In contrast, Murphy et al . reported worse outcomes for T2 disease compared with T3a disease, pushing the case for tumor size as a stronger prognostic factor . Lam et al .…”