Renal cell carcinoma: stage, grade and histology migration over the last 15 years in a large Australian surgical series

Abstract

a male:female ratio of 1.9 : 1. Similarly sized tumours were identified in each time group [group 1 (1993-1997), 54.8 mm; group 2 (1998-2002), 52.0 mm; group 3 (2003-2007), 52.2 mm, P = 0.6].• Pathological stage II disease decreased from 18.1 to 11.1%, but stage III disease showed an increase from 13.9 to 21.5% over that time period ( P = 0.02).• The proportion of stage I and stage IV disease has remained relatively the same. There has been a statistically significant upward histological migration for the papillary subtype from 1.3 to 10.2% ( P = 0.01).• There has also been an increasing representation of Fuhrman grade III tumours over time, from 17.6 to 30.8%, and a decreasing proportion of Fuhrman grade I tumours from 16.2 to 7.1% ( P = 0.03).• There was a decrease in the incidence of benign tumours originally thought to be malignant on preoperative investigations, from 10% in group 1 to 4% in group 3 ( P = 0.03). CONCLUSION• The recent US phenomenon of migration towards earlier-stage, smaller RCCs as well as increased representation of benign tumours was not observed in the present study. The results of the present study, however, show an upward histological migration for papillary RCCs and an increasing representation of more aggressive Fuhrman grade III tumours.

İs The Renal Cell Cancer Stage Migration Valid Throughout The World?

“…The rates determined in this study were 77.6% for clear cell RCC, 9% for papillary RCC, and 5.1% for chromophobe RCC. The histology types in this study showed patterns of frequency similar to those in other studies (7,9).…”

“…The rates of Fuhrman III and IV increased from 21.7% and 4.3% to 33% and 24.5%, comparable to the findings of Doeuk et al, who reported that the rates of Fuhrman III and IV increased from 17.6% and 6.8% to 30.8% and 8.3% (9). However, Pichler et al reported no change in Fuhrman grade in a 25-year period at a European center (8).…”

“…In this study, there was no stage migration, in contrast to Europe-and US-based studies. In another study from Australia, Doeuk et al evaluated the pathological results of 547 patients undergoing radical or partial nephrectomy between January 1993 and December 2007, and they reported that they did not observe any migration towards earlier-stage and smaller RCCs, in line with this study (9). However, in both studies, the assessment of downward stage migration at presentation cannot be fully achieved in terms of study design.…”

Partial and radical nephrectomy provide comparable long‐term cancer control for T1b renal cell carcinoma

“…15,16 In the context of such paradigm shift, PN, historically reserved for a tumor in a solitary kidney, bilateral Partial nephrectomy in T1b RCC renal tumors or renal function impairment, emerged as a viable alternative to RN. There is currently a strong body of literature supporting the use of PN over RN for T1a RCC.…”

Robot-assisted vs. Laparoscopic Partial Nephrectomy: utilization rates and perioperative outcomes

“…Due to the downward stage migration in contemporary years (1,3), utilization Robot-assisted vs. Laparoscopic Partial Nephrectomy: utilization rates and perioperative outcomes _______________________________________________ rate of partial nephrectomy (PN) has increased significantly (4). PN has been demonstrated to provide equivalent oncologic control (5), improved renal function, a lower risk of cardiovascular disease, as well as improved overall survival (6)(7)(8).…”