New Cut-Off Point between T1 and T2 Renal Cell Carcinoma – Necessary for a Better Discriminatory Power of the TNM Classification

Wunderlich, H.; Dreihaupt, M.; Schlichter, A.; Kosmehl, H.; Reichelt, O.; Schubert, J.
February 2004
Urologia Internationalis;Feb2004, Vol. 72 Issue 2, p123
Academic Journal
Purpose: We evaluated the pathological features of tumor size, lymph node and distant metastases, cell type, growth pattern, infiltration pattern, histological grade, local invasion and venous involvement of organ-confined renal carcinomas. The aim of this study was the re-evaluation of the TNM classification and the tumor cut-off point between T1 and T2 for renal cell carcinomas from the 1987 to the 1997 versions. Materials and Methods: (1) Patients with renal cell carcinoma who had been operated between October 1992 and August 2001 were evaluated. 437 of 691 patients showed T1 and T2 tumors. These organ-confined tumors have been divided into five groups: group 1: tumor-size of 20 mm or less (n = 16), group 2: 21–30 mm (n = 79); group 3: 31–40 mm (n = 83; group 4: 41–70 mm (n = 184), and group 5: more than 70 mm in diameter (only T2, n = 75). Follow-up ranged from 0 to 100 months (average 28.63 months). (2) Of 15,347 autopsies performed in Jena between 1985 and 1996, 272 renal cell carcinomas were revealed. In 145 of these 272 cases renal cell carcinomas were limited to the kidney. These 145 tumors were divided accordingly into 5 groups: group 1: 20 mm or less (n = 33), group 2: 21– 30 mm (n = 31); group 3: 31–40 mm (n = 29); group 4: 41–70 mm (n = 42), and group 5: T2 (n = 10). Clinicopathological criteria examined were lymph node and distant metastases, cell type, growth pattern, infiltration pattern, histological grade, local invasion and venous involvement. To identify the optimal cut-off point between T1 and T2 disease the χ[sup 2] test was used. Results: (1) In the clinical series only 1.8% (n = 8) of all cases showed lymph node metastases. Distant metastases were shown in 57 cases (13.04%); within group 1: 0%, group 2: 7.59%, group 3: 1.20%, group 4: 15.76%, group 5: 28%. The tumor grading was statistically correlated with tumor size. (2) In the pathological series 94 of the evaluated 145 patients were downstaged from T2[sub 1987] to T1[sub 1997] . Lymph node and distant metastases were well correlated with tumor size. Lymph node metastases were seen in 0, 12.9, 31, 29.3 and 40% (group 1 to group 5) and distant metastases in 12.1, 25.8, 41.4, 47.7 and 60%. There were no statistically significant differences between T2[sub 1997] and T1[sub 3–7 cm] . The tumor grading was statistically correlated with tumor size (grade 1: in 66.7, 25.8, 17.2, 9.5 and 0%). Conclusion: Our data suggest that the current cut-off diameter between T1 and T2 renal cell carcinomas (7 cm) is too high. Lowering the cut-off level will result in better discriminatory power of the TNM classification. From our data, we conclude that the cut-off diameter should be lowered to 3.5 cm (p < 0.001). Copyright © 2004 S. Karger AG, Basel


Related Articles

  • The Use of the American Society of Anesthesiology Classification as a Prognostic Factor in Patients with Renal Cell Carcinoma. Zequi, Stênio de Cássio; de Campos, Eurico C. R.; Guimarães, Gustavo C.; Bachega Jr., Wilson; da Fonseca, Francisco P.; Lopes, Ademar // Urologia Internationalis;Feb2010, Vol. 84 Issue 1, p67 

    Objectives: We analyzed whether the American Society of Anesthesiology (ASA) classification could be used as a prognostic factor in renal cell carcinoma. Methods: ASA classification’s impact on cancer-specific survival (CSS) and on overall survival in 145 patients submitted to radical or...

  • Late Local and Pulmonary Recurrence of Renal Cell Carcinoma. Froehner; Manseck; Lossnitzer; Wirth // Urologia Internationalis;May98, Vol. 60 Issue 4, p248 

    Locally recurrent renal cell carcinoma and multiple pulmonary metastases were successfully resected in a patient 20 years after nephrectomy.

  • Cutaneous Metastases in Renal Cell Carcinoma. Bujons, A.; Pascual, X.; Martínez, R.; Rodríguez, O.; Palou, J.; Villavicencio, H. // Urologia Internationalis;Jan2008, Vol. 80 Issue 1, p111 

    Cutaneous metastases from a renal cell carcinoma are rarely diagnosed during life. We report a case of renal carcinoma metastatic to the skin that occurred 18 months after kidney removal. The cutaneous metastasis was excised. Cutaneous metastases from urological tumors are uncommon and occur in...

  • Operative Therapy in Disease Progression and Local Recurrence of Renal Cell Carcinoma. Fischer, Claus G.; Schmid, Hans-Peter // Urologia Internationalis;Jul99, Vol. 63 Issue 1, p10 

    When local recurrence or distant metastasis occurs, the question arises as to which therapeutic concept should be applied. In contrast to the data on systemic immunotherapy, there are no systematic studies on surgical management of metastasis. Local recurrence (a rare condition) is frequently...

  • Solitary Contralateral Adrenal Metastasis after Nephrectomy for Renal Cell Carcinoma. Moudouni; En-Nia; Rioux-Leclercq; Guille; Lobel // Urologia Internationalis;May2002, Vol. 68 Issue 4, p295 

    Malignant involvement of the contralateral adrenal gland in cases of renal cell carcinoma is extremely rare. Solitary metachronous metastatic involvement of the contralateral adrenal gland from renal cell carcinoma is rarely diagnosed during life. In fact, clinical signs and symptoms of adrenal...

  • Probability of Ten-Year Survival in Metastatic Renal Cell Carcinoma. Salagierski, Maciej; Salagierski, Marek; Salagierska-Barwińska, Anna; Sosnowski, Marek // Urologia Internationalis;Apr2008, Vol. 80 Issue 3, p335 

    Metastatic renal cancer has a very poor prognosis and constitutes a challenge to uro-oncologists. We present a patient who in the 10 years following the diagnosis of renal cell carcinoma developed nine consecutive metastases in as many sites. He was operated on eleven times in different...

  • Collecting Duct Renal Cell Carcinoma: Two Different Clinical Stages, Two Different Clinical Outcomes. Vá;zquez-Lavista, L. G.; Uribe-Uribe, N.; Gabilondo-Navarro, F. // Urologia Internationalis;Jul2008, Vol. 81 Issue 1, p116 

    Collecting duct carcinoma (CDC) of Bellini is a rare variant of renal cell carcinoma. It tends to be more aggressive when locally advanced or when having distant spread on diagnosis. The only favorable prognosis factor is low-stage, low-grade, with disease-free survival reported up to 5 years....

  • Multifocal Brain Metastases in Clear Cell Renal Cell Carcinoma with Complete Response to Sunitinib. Hao Zeng; Xiang Li; Jin Yao; Yuchun Zhu; Jiyan Liu; Yuru Yang; Wei Qiang // Urologia Internationalis;Dec2009, Vol. 83 Issue 4, p482 

    We report the case of a 70-year-old man who received sunitinib treatment for brain metastatic clear cell renal cell carcinoma. After 6 months of treatment, brain MRI showed complete disappearance of two brain metastases. To the best of our knowledge, this is the first reported case of multifocal...

  • Prostatic Metastasis of Renal Cell Carcinoma Successfully Treated with Sunitinib. Fokt, Ralf-Michael; Templeton, Arnoud; Gillessen, Silke; Öhlschlegel, Christian; Schmid, Hans-Peter // Urologia Internationalis;Jul2009, Vol. 83 Issue 1, p122 

    Metastases of renal cell carcinoma to the prostate gland are very rare. We present a case of a metastasis of renal cell carcinoma in the prostate which occurred 10 years after nephrectomy. Treatment with sunitinib was initiated and a notable response achieved. Copyright © 2009 S. Karger AG, Basel


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics