TNM T3a Renal Cell Carcinoma: Adrenal Gland Involvement is Not the Same as Renal Fat Invasion

Han, Kyung Joon; Bui, Matthew; Pantuck, Allan J.; Freitas, Danielo G.; Leibovich, Bradley C.; Dorey, Frederick J.; Zisman, Amnon; Janzen, Nicolette; Mukouyama, Hideki; Figlin, Robert A.; Belldegrun, Arie S.

doi:10.1097/01.ju.0000051480.62175.35

Cited by 125 publications

(69 citation statements)

References 15 publications

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“…89,90 In the 2002 edition of the TNM classification both direct infiltration of the adrenal gland and infiltration into perirenal fat remain classified as category T3a. From published series this would appear inappropriate as patients with direct extension of tumor into the adrenal gland have been shown to have a poor prognosis, with 5-year survival of 20.2% being similar to that for pT4 tumors.…”

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

confidence: 99%

Advances and controversies in grading and staging of renal cell carcinoma

2009

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“…[7][8][9][10] Therefore, in the revised 2010 TNM staging system, direct adrenal gland invasion was reclassified into the T4 stage. Our results were consistent with those of previous studies and supported this revision.…”

Section: Discussionmentioning

confidence: 99%

Application of the revised Tumour Node Metastasis (TNM) staging system of clear cell renal cell carcinoma in eastern China: advantages and limitations

Qin¹,

Sun²,

Cui³

et al. 2013

Asian J Androl

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This study was designed to evaluate whether the revised 2010 Tumour Node Metastasis (TNM) staging system could lead to a more accurate prediction of the prognosis of renal cell carcinoma (RCC) patients. A total of 1216 patients who had undergone radical nephrectomy or partial nephrectomy for RCC from 2003 to 2011 were enrolled. All of the patients had pathologically confirmed clear cell RCC (ccRCC). All cases were staged by both the 2002 and 2010 TNM staging systems after pathological review, and survival data were collected. Univariate and multivariate Cox regression models were used to evaluate cancer-specific survival (CSS) and progression-free survival (PFS) after surgery. Continuous variables, such as age and tumour diameter, were calculated as mean values and standard deviations (s.d.) or as median values. Survival was calculated by the Kaplan-Meier method, and the log-rank test assessed differences between groups. Statistically significant differences in CSS and PFS were noted among patients in T3 subgroups using the new 2010 staging system. Therefore, the revised 2010 TNM staging system can lead to a more accurate prediction of the prognosis of ccRCC patients. However, when using the revised 2010 staging system, we found that more than 92% of patients (288/313) with T3 tumours were staged in the T3a subgroup, and their survival data were not significantly different from those of patients with T2b tumours. In addition, T2 subclassification failed to independently predict survival in RCC patients.

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“…Because of a small number of patients and based on several reports demonstrating that patients with direct invasion of the adrenal gland have survival comparable to those with tumors involving adjacent organs (pT4 disease), patients with direct adrenal gland invasion were excluded from analyses. 5,7,15 Kaplan-Meier analyses of the risk groupings in the pT3 2002 AJCC primary renal tumor classification revealed decreased disease-specific survival in pT3b patients compared with pT3a RCC patients. Trend analysis revealed that, taken as a whole, the pT3 2002 AJCC RCC classification did not effectively stratify patients according to their risk of death from RCC (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…4 Recently, several centers have clearly demonstrated that tumors with direct ipsilateral invasion of the adrenal gland should be staged as pT4 because they behave more aggressively than tumors involving perinephric or renal sinus fat. [5][6][7] Moreover, controversy exists regarding the prognostic significance of the cranial extension of venous tumor thrombus (VTT), the location of extrarenal extension (ERE), and the concomitant presence of both pathologic features. [8][9][10][11][12][13] By examining the prognostic features and cancerspecific outcomes of a large cohort of patients treated within the past 15 years for RCC at a tertiary referral center, this study seeks to reassess and suggest possible improvements to the 2002 AJCC pT3 classification of RCC.…”

Section: Resultsmentioning

confidence: 99%

Redefining pT3 renal cell carcinoma in the modern era

Margulis

Tamboli

Matin

et al. 2007

Cancer

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Tissue preparation has recently been utilized for detection of neuronal activation in multiple non‐BOLD based functional MRI studies to eliminate vascular contamination. However, undesired signal change could still occur in such systems due to the concentration change of dissolved O2 upon tissue activation. To estimate the impact of such effects, the O2 concentration distribution and the consequent susceptibility field in tissue‐solution systems were simulated with various tissue geometries and experimental parameters. Our results indicate that substantial signal change between the resting and activated states could potentially be induced by the O2 effect in highly oxygenated solutions, and thus caution should be taken in interpreting any signal change observed in such experiments. Magn Reson Med, 2011. © 2010 Wiley‐Liss, Inc.

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TNM T3a Renal Cell Carcinoma: Adrenal Gland Involvement is Not the Same as Renal Fat Invasion

Cited by 125 publications

References 15 publications

Advances and controversies in grading and staging of renal cell carcinoma

Advances and controversies in grading and staging of renal cell carcinoma

Application of the revised Tumour Node Metastasis (TNM) staging system of clear cell renal cell carcinoma in eastern China: advantages and limitations

Redefining pT3 renal cell carcinoma in the modern era

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