Renal cell carcinoma: A clinicopathological follow-up study after radical nephrectomy

Zubac, Damir; Bostad, Leif; Gestblom, Charlotta; Kihl, Björn; Seidal, Tomas; Wentzel‐Larsen, Tore; Bakke, August

doi:10.1080/00365590601016552

Cited by 22 publications

(17 citation statements)

References 30 publications

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“…Studies have produced conflicting results regarding the prognostic significance of tumour necrosis, with some showing an association with poor survival on univariate analysis but not being retained as an independent prognostic factor whilst others have shown no link with prognosis [4,[6][7][8][9] . Klatte et al [10] have shown that an extent-based classification of necrosis is superior to a simple absence/presence response and is retained as an independent prognostic factor.…”

Section: Resultsmentioning

confidence: 99%

“…+44 7967 756 688, E-Mail tahir1 @ doctors.org.uk proliferation and progression [6] . Several studies have investigated tumour necrosis as a prognostic factor for patients with renal cell cancer and reported conflicting results [6][7][8][9] . Necrosis is evaluated on a presence or absence basis and therefore does not take into account the extent of necrosis.…”

Section: Urologiamentioning

confidence: 99%

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Is the Presence or Absence of Tumour Necrosis a Significant Predictor of Survival in Renal Cell Cancer?

Qayyum

McArdle

Going³

et al. 2011

Urol Int

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Objective: Currently when renal cancer pathology is assessed the presence or absence of necrosis is simply reported. It has been suggested that a presence or absence response ignores heterogeneity and a classification based on the extent of necrosis involvement would aid prognostic value in cancer-specific survival. The aim of this study was to determine whether a quantitative assessment of tumour necrosis would provide additional prognostic information. Methods: We studied the pathological features and cancer-specific survival of 47 patients with renal cancer undergoing surgery with curative intent. A quantitative assessment of tumour necrosis was compared to the presence or absence of necrosis. Results: Tumour necrosis was present in 27 of 47 cases. A simple assessment of the presence or absence was not associated with cancer-specific survival (p = 0.052). When assessed quantitatively, tumour necrosis was associated with decreased cancer-specific survival (p < 0.001). A 2-tiered assessment, <25% and >25% involvement of necrosis, was further utilised and shown to predict cancer-specific survival (p < 0.001). On multivariate analysis, using this 2-tiered assessment of <25% and >25% involvement of necrosis was retained as a significant independent factor for cancer-specific survival (HR 11.84, 95% CI 3.81–36.75, p < 0.001). Conclusion: A simple assessment of the presence/absence of tumour necrosis is reported to be a prognostic factor in renal cell cancer. In this study, the presence/absence was not shown to be a significant prognostic marker of cancer-specific survival. However, a more accurate quantitative assessment of tumour necrosis, whereby a 2-tiered response is still utilised, but basing this on <25% and >25% involvement of necrosis was statistically significant and independent in predicting cancer-specific survival.

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Section: Resultsmentioning

confidence: 99%

Section: Urologiamentioning

confidence: 99%

Is the Presence or Absence of Tumour Necrosis a Significant Predictor of Survival in Renal Cell Cancer?

Qayyum

McArdle

Going³

et al. 2011

Urol Int

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“…It was therefore of interest that a simplified assessment of the local inflammatory cell infiltrate [13] , which is not as time consuming as quantifying lymphocyte subsets, has been shown to be prognostic in colorectal cancer [13,14] . The role of necrosis in renal cancer, despite being utilised in prognostic algorithms, has produced conflicting results [2,[26][27][28][29] . In this study, neither local inflammatory response nor necrosis were significant for disease-specific survival.…”

Section: Discussionmentioning

confidence: 99%

“…Despite using necrosis in prognostic algorithms in renal cancer, there are still some conflicting results regarding its prognostic significance with some showing an association with poor survival on univariate analysis but not being retained as an independent prognostic factor whilst others have shown no link with prognosis [2,[26][27][28][29] .…”

Section: Introductionmentioning

confidence: 99%

Prospective Study of the Role of Inflammation in Renal Cancer

Qayyum

McArdle²,

Lamb³

et al. 2012

Urol Int

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Background: The local and systemic inflammatory responses provide prognostic information in cancer. The modified Glasgow Prognostic Score (mGPS) provides additional prognostic information than C-reactive protein (CRP) alone when assessing the systemic inflammation in cancer. The aim of this study was to determine the role of local and systemic inflammation in renal cancer. Methods: The cohort consisted of 79 patients who had undergone potential curative resection. Systemic inflammation, mGPS, was constructed by measuring preoperative CRP and albumin concentrations and the Klintrup-Makinen score was evaluated histologically for the local inflammatory response. Pathological parameters such as T stage, grade and tumour necrosis were also assessed. The local inflammatory response was assessed by examining all inflammatory cells at the tumour edge on diagnostic haematoxylin and eosin slides. Results: On univariate analysis, T stage (p < 0.001), grade (p = 0.044) and mGPS (p < 0.001) were significant predictors of cancer-specific survival. On multivariate analysis, mGPS (hazard ratio 8.64, 95% confidence interval 3.5–21.29, p < 0.001) was the only significant independent predictor of cancer-specific survival. Conclusion: A preoperative systemic inflammatory response as measured by the mGPS is an independent predictor of poor cancer-specific survival in renal cancer in patients undergoing potential curative resection.

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“…In the majority of reports (16 out of 20) there was an association between the presence of tumor necrosis and poorer prognosis including reduced overall survival [16][17][18], reduced cancer-specific survival [8,13,15,[19][20][21][22][23][24][25] and increased risk of metastases or disease recurrence [26][27][28]. The largest study relating to RCC was undertaken by Sengupta and coworkers who examined the pathology of over 3000 patients and reported an increased risk of cancer death in patients with necrosis, even after making a djustments for tumor size, grade and stage [13].…”

Section: Tumor Necrosis In Renal and Transitional Cell Malignancymentioning

confidence: 99%

The Prognostic Value of Histological Tumor Necrosis in Solid Organ Malignant Disease: A Systematic Review

Richards¹,

et al. 2011

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There is now a substantial body of evidence confirming the prognostic value of tumor necrosis in solid organ malignant disease. There are consistent associations between necrosis and the presence of other high-risk tumor characteristics but the survival impact appears to be independent of pathological stage. We propose that relationships with the host inflammatory response, both local and systemic, may explain the influence of tumor necrosis on cancer outcome.

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Renal cell carcinoma: A clinicopathological follow-up study after radical nephrectomy

Abstract: ECOG PS, TNM stage, nuclear grade and tumour necrosis were found to be independent prognostic factors for survival.

Cited by 22 publications

References 30 publications

Is the Presence or Absence of Tumour Necrosis a Significant Predictor of Survival in Renal Cell Cancer?

Is the Presence or Absence of Tumour Necrosis a Significant Predictor of Survival in Renal Cell Cancer?

Prospective Study of the Role of Inflammation in Renal Cancer

The Prognostic Value of Histological Tumor Necrosis in Solid Organ Malignant Disease: A Systematic Review

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