Viruses Treatment Articles

Influence Of Clinical & Pathological Stage Discrepancy On Cancer Specific Survival In Patients Treated For Renal Cell Carcinoma

May 06, 2017

UroToday- Much has been made of the advances in radiographic imaging that can be utilized to provide staging information for patients with cancer. Critics argue that clinical staging is inadequate and that complete pathologic examination of a resected surgical specimen is the gold standard for the identification of factors that may influence outcome. Here, Svatek and colleagues examine the discrepancies between clinical and pathological staging in patients with renal cell carcinoma (RCC) to determine whether clinical understaging may influence our ability to predict patient outcomes following curative therapy.

The authors examined 264 patients that presented with clinical T1-3 RCC over a 9 year period. Of these, 203 were treated with radical nephrectomy whereas 61 were treated with partial nephrectomy. Clear cell histology was present in 84.5%, papillary in 10.2%, and chromophobe in 5.3% of patients. With a median follow-up of 24 months (range 2-122), 23.9% of patients have recurrence of disease and 9.1% have died from RCC. In the examination of the pathologic specimens, the authors found that 44/264 (17%) were upstaged from their clinical staging designation, including 18.5% of clinical T1 and 21.2% of clinical T2 patients. Pathologic upstaging was associated with a worse prognosis. The 5 year recurrence free survival (RFS) for clinical T1 patients that were pathologically upstaged was 47.4% versus 84.3% in those that were not, and the 5 year RFS for clinical T2 patients that were pathologically upstaged was 40.7% versus 80% in those that were not (p