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Reassessing the current TNM lymph node staging for renal cell carcinoma
Carlo Terrone1, C Cracco, F Porpiglia
1Divisione di Urologica, Università di Torino, Azienda Ospedaliera S. Luigi, Orbassano, Italy. carlo.terrone@unito.it
European Urology
|January 3, 2006
Summary
The current TNM staging for renal cell carcinoma (RCC) lymph node involvement lacks prognostic value. A revised approach using >4 involved lymph nodes and lymph node density better predicts survival outcomes in RCC patients.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- The tumor-node-metastasis (TNM) system is standard for renal cell carcinoma (RCC) staging.
- Current TNM criteria define lymph node (LN) involvement as pN0, pN1, or pN2 based on the number of positive LNs.
Purpose of the Study:
- To evaluate the prognostic significance of the current TNM LN classification in RCC.
- To explore the utility of lymph node density (LND) as an additional prognostic parameter.
Main Methods:
- Retrospective review of 735 radical nephrectomy reports for RCC.
- Data collected included number of LNs removed, number of positive LNs, and LND.
- Kaplan-Meier survival analysis and log-rank tests were employed.
Main Results:
- The 5-year survival rate for pN+ patients was 18%.
- No significant difference in survival was observed between pN1 and pN2 classifications.
- Factors significantly predicting unfavorable prognosis included >4 involved LNs and LND >60%.
Conclusions:
- The current TNM classification for LN involvement in RCC has limited prognostic correlation.
- A revised staging incorporating the number of involved LNs (>4) and LND offers improved prognostic accuracy for RCC survival.