The staging of renal cell carcinoma

Accurate staging of renal cell carcinoma is essential for patient care. The current staging system provides a common language to describe extent of disease, stratifies surveillance requirements, provides prognostic information, and selects patients for adjuvant clinical trials. We describe the current tumor, nodes, metastasis system, existing problems and controversies, and introduce integrated staging systems such as the University of California, Los Angeles Integrated Staging System and the Stage, Size, Grade, and Necrosis scoring algorithm. Important differences in the utility of the commonly used nomograms are briefly outlined.

Several recent reports have demonstrated problems with the current tumor, nodes, metastasis staging system, especially for patients with advanced disease. A revision of the 2002 tumor, nodes, metastasis system is expected in the next few years and may incorporate some of these findings. Additionally, several new integrated staging systems have been introduced which can aid in clinical decisions. Many of the current nomograms and scoring algorithms have been externally validated and have higher accuracy than the tumor, nodes, metastasis system alone.

Knowledge of renal cell carcinoma staging is necessary for clinicians to accurately counsel patients. Several adjuvant trials rely on these staging systems for patient selection criteria. Continued refinements in the tumor, nodes, metastasis system and integrated staging systems should ultimately lead to improved care.