Prognostication in Kidney Cancer: Recent Advances and Future Directions

The most common type of cancer originating in the kidney is renal cell carcinoma (RCC). In both localized and advanced RCC, a number of clinical, pathologic, and molecular factors have been identified as having prognostic significance. In localized disease, risk stratification has traditionally involved the anatomic extent of disease, and several integrated scoring systems have been developed to help predict outcomes after definitive local therapy. In metastatic RCC, integrated prognostic models have also been established. These are used to stratify patients in contemporary clinical trials and to guide risk-directed treatment selection in clinical practice. Although many prognostic factors are common to both localized and advanced disease, there are some important distinctions. In both of these types of disease, the prognostic role of specific molecular and genomic alterations is an area of active investigation. In this review, we highlight the current staging systems and prognostic factors in localized and metastatic RCC. We also explore future directions in this area, including the expanding role of molecular biomarkers and their integration into the traditional prognostic models.