| The Influence of Clinical and Pathological Stage Discrepancy on Cancer Specific Survival in Patients Treated for Renal Cell Carcinoma |
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| Thursday, 08 March 2007 | ||||
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BERKELEY, CA (UroToday.com) - 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 less than 0.0002). The 5 year cancer specific survival (CSS) for clinical T1 patients that were pathologically upstaged was 69.7% versus 98.5% in those where it wasn't (p=0.0005). The 5 year CSS for clinical T2 patients that were pathologically upstaged was 72.7%, versus 90.9% in those where it wasn't (p=0.0501). This study demonstrates that approximately 20% of patients with clinically localized RCC are clinically understaged using existing imaging paradigms, and that this understaging can significantly influence our ability to predict prognosis. The increased reliance on imaging alone for local staging information when the primary tumor is not resected (energy ablative strategies) may be influenced by this significant discrepancy. Svatek RS, Lotan Y, Hermann M, Duchene DA, Sagalowsky AI, Cadeddu JA J Urol 176(4):1321-1325, 2006. UroToday.com Renal Cancer Section
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