Related Experiment Videos
Renal cell carcinoma invading the urinary collecting system: implications for staging
Robert G Uzzo1, Edward E Cherullo, Jonathan Myles
1Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
The Journal of Urology
|May 7, 2002
Summary
Renal cell carcinoma invading the urinary collecting system is typically large, high-grade, and advanced stage. While prognosis for high-stage tumors is poor, localized urothelial invasion may worsen survival compared to similar stages without invasion.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- Current TNM staging for renal cell carcinoma (RCC) focuses on tumor size, nodal status, and metastasis.
- RCC can invade surrounding tissues, including the adrenal glands, renal vein, vena cava, and urinary collecting system.
- The prognostic significance of urothelial invasion in RCC is not well-defined within existing staging systems.
Purpose of the Study:
- To evaluate the incidence and characteristics of renal cell carcinoma invading the urinary collecting system.
- To assess the impact of urothelial invasion on cancer-specific survival in RCC patients.
- To determine if urothelial invasion warrants inclusion in current TNM staging for RCC.
Main Methods:
- Retrospective review of 504 kidneys from 475 RCC patients.
- Pathological assessment for gross or histological evidence of urothelial invasion.
- Comparison of survival data between tumors with and without urothelial involvement.
Main Results:
- Urothelial invasion was identified in 14% (61/426) of evaluable cases, with a mean lesion diameter of 10.2 cm.
- Most invading tumors were clear cell or sarcomatoid histology, high-grade (Fuhrman grade III/IV), and advanced stage (pT3 or greater).
- Vascular invasion (62%) and vena caval thrombus (26%) were common; median disease-specific survival was 19 months, but 46 months for localized pT1/pT2N0M0 with invasion.
Conclusions:
- RCC invading the renal collecting system is typically large, high-grade, and advanced-stage, with clear cell histology being most common.
- Prognosis for high-stage urothelial-invasive RCC is poor, similar to non-invasive advanced stages.
- While localized urothelial invasion may portend worse survival than expected for its stage, its inclusion in TNM staging may not significantly alter prognostic or therapeutic decisions.