Modified cancer TNM classification for localized renal cell carcinoma based on the prognostic analysis of 3748 cases from a single center

The optimal cutoff point for evaluating the prognosis of localized renal cell carcinoma (LRCC) remains unclear. This study aimed to verify the efficacy of tumor diameter in the 2010 American Joint Committee on Cancer (AJCC) TNM staging system and contribute to the modification of TNM staging on the prognosis of this disease. A total of 3748 patients with LRCC were enrolled and grouped according to the 2010 AJCC TNM staging system. COX analysis was used to stratify the prognosis. The optimal cutoff point of the tumor diameter in the T1 and T2 prognosis was explored. There were 3330 (88.9%) patients in stage T1 and 418 (11.1%) in stage T2. The cancer-specific mortality rate was 2.7% (100/3748). The mean follow-up was 49.8 months. A tumor diameter of 7 cm can determine the prognosis of patients at stages T1 and T2; however, 4.5 cm and 11 cm as the cutoff points for T1 and T2 sub-classification of patients with LRCC might show better recognition ability than 4 cm and 10 cm, respectively. The 2010 AJCC TNM stage can predict the prognosis of LRCC in stages T1 and T2. In addition, a tumor diameter of 4.5 cm and 11 cm might be the optimal cutoff points for the sub-classification of stages T1 and T2.

A Real-World, Population-Based Retrospective Analysis of Therapeutic Survival for Recurrent Localized Renal Cell Carcinoma After Nephrectomy

We retrospectively analyzed therapeutic strategies and risk factors for overall survival (OS) in disease recurrence following curative nephrectomy for localized renal cell carcinoma (loRCC) using the Korean National Cancer Registry Database. We selected 1295 recurrent loRCC patients who underwent either partial or radical nephrectomy from 2007–2013. Patients were excluded for age <19 years, secondary RCC, multiple primary tumors, other SEER stages except for a localized or regional stage, postoperative recurrence within 3-month, and non-nephrectomized cases. Four therapeutic groups were statistically analyzed for OS and risk factors: surgery (OP, 12.0%), other systemic therapy (OST, 59.5%), radiotherapy (RT, 2.8%), and targeted therapy (TT, 25.8%). The overall mortality rate for recurrent loRCC was 32.5%, including 82.4% for RCC-related deaths. The baseline comparison among groups showed statistical differences for the diagnostic age of cancer and the SEER stage (p<0.05). Multivariate analysis of OS showed significance for the TT (hazard ratio [HR]: 6.27), OST (HR: 7.05), and RT (HR: 7.47) groups compared with the OP group, along with significance for the sex, SEER stage, and the time from nephrectomy to treatment for disease recurrence (p<0.05). The median OS curve showed a significantly better OS in the OP group (54.9 months) compared with the TT, OST, and RT groups (41.7, 42.9, and 38.0 months, respectively; p<0.001). In conclusion, the surgery-treated group had the best OS among the different therapeutic strategies for recurrent loRCC after nephrectomy, and the importance of the time from nephrectomy to secondary treatment was a significant prognostic factor.

Surgical Options for Localized Renal Cell Carcinoma, A Retrospective Clinical Study Based on Tumor Size

PurposeAlthough many studies have explored the options of radical nephrectomy (RN) and nephron sparing surgery (NSS) for localized renal cell carcinoma (RCC), the answer to this question remains unclear. This study aims to compare the long-term prognostic differences between RN and NSS among different sizes of localized RCC.MethodsThis study retrospectively included 80,439 T1-T4 N0 M0 patients who underwent RN or NSS based on the Surveillance, Epidemiology, and End Results database. We calculated the 10-year overall survival (OS) and cancer specific survival of patients with RCC. We also evaluated the risk of cardiovascular death in patients using competing risk models for RN and NSS.ResultsOur analysis showed that patients who underwent NSS had a more prolonged OS of 5 and 10 years when the tumor size was less than 8.5cm and 7.2cm. Compared to RN, NSS does not appear to improve OS in large (> 7.2cm) RCC patients. And stratified analysis showed that NSS for RCC less than 9.2cm may be more likely to benefit from long-term OS in younger patients (<60 years), while RCC above 7.3cm may be more suitable for RN in older patients (>=60 years). The gender-stratified results suggested male and female patients may be more suitable for NSS for RCC below 6.4 and 7.7cm, respectively. Besides, competing risk models showed patients receiving RN have higher cumulative cardiovascular mortality.ConclusionsFor large RCC, NSS may be very carefully selected unless there are clear indications such as isolated congenital kidney and bilateral kidney cancer.