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1. Fassnacht M, Johanssen S, Quinkler M, Bucsky P, Willenberg HS, Beuschlein F, Terzolo M, Mueller HH, Hahner S, Allolio B, German Adrenocortical Carcinoma Registry Group, European Network for the Study of Adrenal Tumors: Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma: proposal for a Revised TNM Classification. Cancer; 2009 Jan 15;115(2):243-50
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma: proposal for a Revised TNM Classification.
  • BACKGROUND: Adrenocortical carcinoma (ACC) is a rare malignancy, and it was only in 2004 that the International Union Against Cancer (UICC) defined TNM criteria and published the first staging classification.
  • METHODS: The German ACC Registry comprising 492 patients was searched for patients who were diagnosed between 1986 and 2007 with detailed information on primary diagnosis and a minimum follow-up of 6 months.
  • Patients were assigned to UICC tumor stage, and disease-specific survival (DSS) was assessed.
  • An analysis of different potential risk factors for defining stage III ACC revealed important roles in DSS for tumor infiltration in surrounding tissue, venous tumor thrombus (VTT), and positive lymph nodes; whereas tumor invasion in adjacent organs carried a prognosis similar to that of infiltration in surrounding tissue only.
  • CONCLUSIONS: The 2004 UICC staging classification for ACC has significant limitations.
  • On the basis of the current analysis, a revised classification with superior prognostic accuracy is proposed (the European Network for the Study of Adrenal Tumors classification).
  • [MeSH-major] Adrenocortical Carcinoma / pathology. Neoplasm Staging / classification
  • [MeSH-minor] Humans. Lymphatic Metastasis. Neoplasm Invasiveness. Neoplasm Metastasis. Prognosis. Risk Factors

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  • [Copyright] Copyright (c) 2009 American Cancer Society.
  • [CommentIn] Cancer. 2009 Dec 15;115(24):5847; author reply 5848 [19827149.001]
  • (PMID = 19025987.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Investigator] Allolio B; Behrend M; Bucsky P; Brauckhoff M; Fasanacht M; Fottner C; Haaf M; Hahner S; Johanssen S; Koschker AC; Langer P; Laubner K; Linden T; Maeder U; Morcos M; Oelkers W; Quinkler M; Reincke M; Reisch N; Saeger W; Weismann D; Willenberg HS; Wortmann S; Baudin E; Bertherat J; Beuschlein F; Mannelli M; Terzolo M
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2. Rankin SC: Staging of non-small cell lung cancer (NSCLC). Cancer Imaging; 2006;6:1-3
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  • [Title] Staging of non-small cell lung cancer (NSCLC).
  • Staging of non-small lung cancer (NSCLC) uses the TNM classification and is undertaken to identify those patients who are surgical candidates, either initially or after chemo-radiotherapy, and to differentiate patients who will be treated radically from those requiring palliation and to plan radiotherapy fields.
  • Computed tomography and magnetic resonance imaging (MRI) are used in staging and provide anatomical information but have well known limitations in differentiating reactive from malignant nodes, fibrosis from active disease and in defining the extent of invasion.
  • Functional imaging using [2-(18F)]fluorodeoxyglucose positron emission tomography is increasingly being used to provide unique information and when combined with anatomic imaging will provide better staging information for both local disease and the extent of metastases.
  • [MeSH-major] Carcinoma, Non-Small-Cell Lung / pathology. Diagnostic Imaging. Lung Neoplasms / pathology. Neoplasm Staging / methods
  • [MeSH-minor] Adrenal Gland Neoplasms / secondary. Fluorodeoxyglucose F18. Humans. Magnetic Resonance Imaging. Positron-Emission Tomography. Radiopharmaceuticals. Sensitivity and Specificity

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  • [Copyright] International Cancer Imaging Society.
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  • (PMID = 16478697.001).
  • [ISSN] 1470-7330
  • [Journal-full-title] Cancer imaging : the official publication of the International Cancer Imaging Society
  • [ISO-abbreviation] Cancer Imaging
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Radiopharmaceuticals; 0Z5B2CJX4D / Fluorodeoxyglucose F18
  • [Other-IDs] NLM/ PMC1693760
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3. Quint LE: Staging non-small cell lung cancer. Cancer Imaging; 2007;7:148-59
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  • [Title] Staging non-small cell lung cancer.
  • Patients with newly diagnosed non-small cell lung cancer (NSCLC) need accurate tumor staging in order to direct appropriate therapy and establish prognosis; the tumor is usually staged using the TNM system.
  • The major imaging modalities currently used for staging this disease are thoracic computed tomography (CT) (including the adrenal glands) and whole body fluorodeoxyglucose (FDG)-positron emission tomography (PET) scanning.
  • CT is generally most useful in evaluating the T stage, i.e. local spread of the neoplasm, whereas PET is most helpful in assessing the N and M stages, i.e. regional and distant tumor spread, respectively.
  • Staging accuracy using any of these imaging techniques is imperfect; therefore, pathologic confirmation of positive findings is recommended, whenever possible, before denying a patient potentially curative therapy.
  • [MeSH-major] Carcinoma, Non-Small-Cell Lung / pathology. Lung Neoplasms / pathology. Neoplasm Staging / methods

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  • (PMID = 17964957.001).
  • [ISSN] 1470-7330
  • [Journal-full-title] Cancer imaging : the official publication of the International Cancer Imaging Society
  • [ISO-abbreviation] Cancer Imaging
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] England
  • [Number-of-references] 56
  • [Other-IDs] NLM/ PMC2072091
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4. Hintze C, Dinkel J, Biederer J, Heussel CP, Puderbach M: [New procedures. Comprehensive staging of lung cancer by MRI]. Radiologe; 2010 Aug;50(8):699-705
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  • [Title] [New procedures. Comprehensive staging of lung cancer by MRI].
  • [Transliterated title] Neue Verfahren. Umfassendes Staging des Lungenkarzinoms mit der MRT.
  • Lung cancer staging according to the TNM system is based on morphological assessment of the primary cancer, lymph nodes and metastases.
  • The predominant metastatic spread to the adrenal glands and spine can be detected in coronal orientation during dedicated MRI of the lungs.
  • Search focused whole body MRI completes the staging.
  • In the oncological context the most important techniques are imaging of perfusion and tumor motion.
  • Functional MRI of the lungs complements the pure staging and improves surgical approaches and radiotherapy planning.
  • [MeSH-minor] Adrenal Gland Neoplasms / blood supply. Adrenal Gland Neoplasms / pathology. Adrenal Gland Neoplasms / secondary. Disease Progression. Humans. Lymph Nodes / pathology. Lymphatic Metastasis / pathology. Neoplasm Staging. Positron-Emission Tomography. Sensitivity and Specificity. Spinal Neoplasms / blood supply. Spinal Neoplasms / pathology. Spinal Neoplasms / secondary. Stochastic Processes. Tomography, Emission-Computed, Single-Photon. Tomography, X-Ray Computed

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  • (PMID = 20628723.001).
  • [ISSN] 1432-2102
  • [Journal-full-title] Der Radiologe
  • [ISO-abbreviation] Radiologe
  • [Language] ger
  • [Publication-type] English Abstract; Journal Article; Review
  • [Publication-country] Germany
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5. Bodtger U, Vilmann P, Clementsen P, Galvis E, Bach K, Skov BG: Clinical impact of endoscopic ultrasound-fine needle aspiration of left adrenal masses in established or suspected lung cancer. J Thorac Oncol; 2009 Dec;4(12):1485-9
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  • [Title] Clinical impact of endoscopic ultrasound-fine needle aspiration of left adrenal masses in established or suspected lung cancer.
  • INTRODUCTION: Correct lung cancer staging is pivotal for optimal allocation to surgical and nonsurgical treatment.
  • A left adrenal gland (LAG) mass is found in 5 to 16%, and malignancy preclude surgery.
  • Endoscopic ultrasound (EUS) is superior to other imaging procedures in visualizing LAG, but the impact of EUS-fine needle aspiration (FNA) on tumor, node, metastasis (TNM)-staging, treatment, and survival is unknown.
  • METHODS: The impact of EUS-FNA of the LAG on TNM staging, treatment, and survival was evaluated retrospectively in all patients (n = 40) referred to EUS during 2000-2006 for known or suspected lung cancer and where EUS disclosed an enlarged LAG.
  • RESULTS: EUS-FNA of an enlarged LAG altered the TNM staging in 70% (downstaged: 26 of 28 patients) and treatment in 48% (gained surgery 25%, avoided surgery 5%, surgically verified benign disease 5%, no cancer and no further workup 5%, and no cancer, control computed tomography, and then no further workup 8%).
  • A malignant LAG lesion was found in 28% and was significantly associated with shorter survival.
  • CONCLUSION: EUS-FNA of an enlarged LAG in patients with known or suspected lung cancer had a significant impact on TNM staging, treatment, and survival.
  • The impact of routine visualization of the LAG in lung cancer workup needs to be prospectively validated.
  • [MeSH-major] Adrenal Gland Neoplasms / pathology. Biopsy, Fine-Needle / methods. Endoscopy. Lung Neoplasms / pathology. Lung Neoplasms / ultrasonography. Mediastinal Neoplasms / pathology
  • [MeSH-minor] Adenocarcinoma / pathology. Adenocarcinoma / surgery. Adenocarcinoma / ultrasonography. Adult. Aged. Carcinoma, Large Cell / pathology. Carcinoma, Large Cell / surgery. Carcinoma, Large Cell / ultrasonography. Carcinoma, Non-Small-Cell Lung / pathology. Carcinoma, Non-Small-Cell Lung / surgery. Carcinoma, Non-Small-Cell Lung / ultrasonography. Carcinoma, Squamous Cell / pathology. Carcinoma, Squamous Cell / surgery. Carcinoma, Squamous Cell / ultrasonography. Endosonography. Female. Follow-Up Studies. Humans. Lymphatic Metastasis. Male. Middle Aged. Neoplasm Staging. Preoperative Care. Prognosis. Retrospective Studies. Small Cell Lung Carcinoma / pathology. Small Cell Lung Carcinoma / surgery. Small Cell Lung Carcinoma / ultrasonography. Treatment Outcome


6. Bedke J, Buse S, Pritsch M, Macher-Goeppinger S, Schirmacher P, Haferkamp A, Hohenfellner M: Perinephric and renal sinus fat infiltration in pT3a renal cell carcinoma: possible prognostic differences. BJU Int; 2009 May;103(10):1349-54
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  • OBJECTIVE: To evaluate the influence of perinephric (PN) and renal sinus (RS) fat infiltration on cancer-specific survival beyond other prognostic factors, as the Tumour-Node-Metastasis (TNM) classification system defines stage T3a renal cell carcinoma (RCC) as infiltration of perirenal fat and/or direct infiltration of the adrenal gland.
  • In this group of RS + PN fat infiltration the 5-year cancer-specific survival was 31%.
  • We recommend that perirenal fat infiltration should be further differentiated into RS fat or PN infiltration in the TNM classification.
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Epidemiologic Methods. Female. Humans. Lymphatic Metastasis. Male. Middle Aged. Neoplasm Staging. Prognosis

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  • (PMID = 19076147.001).
  • [ISSN] 1464-410X
  • [Journal-full-title] BJU international
  • [ISO-abbreviation] BJU Int.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
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7. Delahunt B: Advances and controversies in grading and staging of renal cell carcinoma. Mod Pathol; 2009 Jun;22 Suppl 2:S24-36
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  • [Title] Advances and controversies in grading and staging of renal cell carcinoma.
  • Independent of tumor grade, the prognostic importance of tumor stage for RCC is well recognized.
  • The Union Internationale Contre le Cancer/American Joint Committee for Cancer Staging and End Results Reporting TNM staging system is now in its sixth edition (2002) and recent refinements have focused on defining size cut points that will identify apparently localized tumors that will develop recurrence and/or metastases despite attempted curative surgery.
  • Questions remain as to the appropriate stratification of regional extension of RCC, as defined in the T3 tumor-staging category.
  • Recent modifications to this category have been suggested combining the level of infiltration of the venous outflow tract with the presence or absence of infiltration of the adrenal gland and/or perirenal fat.
  • Similarly, the utility of classifying lymph node involvement by tumor is debated, although it is well recognized that lymph node infiltration is associated with a poor prognosis.
  • Although the current TNM classification does provide useful prognostic information it would appear that further modifications are justified to enhance the predictive value of staging for RCC.
  • [MeSH-major] Carcinoma, Renal Cell / classification. Carcinoma, Renal Cell / pathology. Kidney Neoplasms / classification. Kidney Neoplasms / pathology. Neoplasm Staging / methods

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  • (PMID = 19494851.001).
  • [ISSN] 1530-0285
  • [Journal-full-title] Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc
  • [ISO-abbreviation] Mod. Pathol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 118
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8. Moch H, Artibani W, Delahunt B, Ficarra V, Knuechel R, Montorsi F, Patard JJ, Stief CG, Sulser T, Wild PJ: Reassessing the current UICC/AJCC TNM staging for renal cell carcinoma. Eur Urol; 2009 Oct;56(4):636-43
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  • [Title] Reassessing the current UICC/AJCC TNM staging for renal cell carcinoma.
  • CONTEXT: The outcome prediction for renal cell cancer (RCC) remains controversial, and although many parameters have been tested for prognostic significance, only a few have achieved widespread acceptance in clinical practice.
  • The TNM staging system defines local extension of the primary tumour (T), involvement of regional lymph nodes (N), and presence of distant metastases (M).
  • OBJECTIVE: This review focuses on reassessing the current TNM staging system for RCC.
  • EVIDENCE ACQUISITION: A literature search in English was performed using the National Library of Medicine database and the following keywords: renal cell cancer, kidney neoplasm, and staging.
  • As a consequence, many modifications of the TNM staging system were primarily made to the size cut points between stage I and II tumours.
  • The latest three revisions of the TNM system are systematically reviewed.
  • In detail, perirenal fat invasion, direct infiltration of the ipsilateral adrenal gland, invasion of the urinary collecting system, infiltration of renal sinus fat, and vena cava and renal vein thrombosis are disputed.
  • Finally, staging of lymph node metastases and distant metastatic disease is discussed.
  • In view of new treatment opportunities, the current TNM staging system of RCC and any other staging system must be dynamic.
  • [MeSH-minor] Humans. Neoplasm Invasiveness. Neoplasm Staging / standards

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  • (PMID = 19595500.001).
  • [ISSN] 1873-7560
  • [Journal-full-title] European urology
  • [ISO-abbreviation] Eur. Urol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] Switzerland
  • [Number-of-references] 62
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9. Fandella A, Borghesi M, Bertaccini A: Renal cell carcinoma. 2002 TNM classification is still adequate? Arch Ital Urol Androl; 2009 Mar;81(1):51-5
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  • [Title] Renal cell carcinoma. 2002 TNM classification is still adequate?
  • The TNM classification should be a tool that allows the physician to make therapeutic decisions and gain even a prognostic scheme.
  • Currently, the 2002 TNM classification for kidney cancer doesn't have these features.
  • Moreover, the T2 category, isto-pathologically restricted, receives less than 2% of all kidney cancers; into the T3 category, if there is also adrenal invasion, it makes a worse prognostic trend, similar to T4 category.
  • The TNM classification, moreover, is inaccurate and unclear regarding the staging of lymph node involvement.
  • For these reasons the TNM classification for parenchymal renal cell carcinoma is unreliable, so an appropriate review of the classification is needed.

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  • (PMID = 19499760.001).
  • [ISSN] 1124-3562
  • [Journal-full-title] Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica
  • [ISO-abbreviation] Arch Ital Urol Androl
  • [Language] ENG
  • [Publication-type] Journal Article; Review
  • [Publication-country] Italy
  • [Number-of-references] 41
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10. Ficarra V, Novara G, Iafrate M, Cappellaro L, Bratti E, Zattoni F, Artibani W: Proposal for reclassification of the TNM staging system in patients with locally advanced (pT3-4) renal cell carcinoma according to the cancer-related outcome. Eur Urol; 2007 Mar;51(3):722-9; discussion 729-31
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  • [Title] Proposal for reclassification of the TNM staging system in patients with locally advanced (pT3-4) renal cell carcinoma according to the cancer-related outcome.
  • OBJECTIVES: The optimal stratification of locally advanced renal cell carcinoma (RCC) is controversial, with the prognostic relevance of ipsilateral adrenal gland invasion and cranial extension of vena cava thrombosis being the most debatable issues.
  • RESULTS: At a median follow-up of 29 mo, we censored 108 (47.6%) cancer-related deaths.
  • According to cancer-related outcome, we identified three subgroups of patients with different prognoses: pT3a(n): tumors with perirenal fat invasion or renal vein thrombosis or thrombosis within the vena cava below the diaphragm; pT3b(n): tumors with renal vein thrombosis or thrombosis within the vena cava below the diaphragm and concomitant perirenal fat invasion; pT4(n): adrenal gland or Gerota fascia invasion or thrombosis within the vena cava above the diaphragm.
  • CONCLUSIONS: The 2002 version of TNM of locally advanced RCC did not stratify patient outcome.
  • The present study suggests the possibility of reclassifying pT3-4 RCC into three categories capable of predicting cancer-specific survival, regardless of all other prognostic factors.
  • [MeSH-minor] Aged. Female. Humans. Male. Middle Aged. Neoplasm Staging / classification. Survival Rate


11. Novara G, Ficarra V, Antonelli A, Artibani W, Bertini R, Carini M, Cosciani Cunico S, Imbimbo C, Longo N, Martignoni G, Martorana G, Minervini A, Mirone V, Montorsi F, Schiavina R, Simeone C, Serni S, Simonato A, Siracusano S, Volpe A, Carmignani G, SATURN Project-LUNA Foundation: Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: are further improvements needed? Eur Urol; 2010 Oct;58(4):588-95
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  • [Title] Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: are further improvements needed?
  • BACKGROUND: A new edition of the TNM was recently released that includes modifications for the staging system of kidney cancers.
  • Specifically, T2 cancers were subclassified into T2a and T2b (< or =10 cm vs >10 cm), tumors with renal vein involvement or perinephric fat involvement were classified as T3a cancers, and those with adrenal involvement were classified as T4 cancers.
  • OBJECTIVE: Our aim was to validate the recently released edition of the TNM staging system for primary tumor classification in kidney cancer.
  • MEASUREMENTS: Univariable and multivariable Cox regression models addressed cancer-specific survival (CSS) after surgery.
  • In multivariable analysis, the novel classification of the primary tumor was a powerful independent predictor of CSS (p for trend <0.0001).
  • CONCLUSIONS: The recently released seventh edition of the primary tumor staging system for kidney tumors is a powerful predictor of CSS.
  • [MeSH-major] Carcinoma, Renal Cell / pathology. Kidney Neoplasms / pathology. Neoplasm Staging / standards

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  • [Copyright] Copyright 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
  • [CommentIn] J Urol. 2011 Apr;185(4):1223 [22115474.001]
  • [CommentIn] Eur Urol. 2010 Oct;58(4):517-9; discussion 519-21 [20728266.001]
  • [ErratumIn] Eur Urol. 2011 Jan;59(1):182. Schiavina, Roberto [corrected to Schiavina, Riccardo]
  • (PMID = 20674150.001).
  • [ISSN] 1873-7560
  • [Journal-full-title] European urology
  • [ISO-abbreviation] Eur. Urol.
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study; Validation Studies
  • [Publication-country] Switzerland
  • [Investigator] De Cobelli O; Schiavina R; Antonelli A; Corti S; Cosciani Cunico S; Simeone C; Castelli M; Cimino S; Favilla V; Morgia G; Billia M; Terrone C; Volpe A; Imbimbo C; Longo N; Mirone V; Carini M; Masieri L; Minervini A; Serni S; Carmignani G; Oneto F; Simonato A; Varca V; Rocco F; Artibani W; Ficarra V; Novara G; Costantini E; Porena M; Zucchi A; Morgia G; Ciciliato S; Lampropoulou N; Siracusano S; Fontana D; Gontero P; Tizzani A; Brunelli M; Martignoni G; Valotto C; Zattoni F
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12. Nguyen CT, Campbell SC: Staging of renal cell carcinoma: past, present, and future. Clin Genitourin Cancer; 2006 Dec;5(3):190-7
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Staging of renal cell carcinoma: past, present, and future.
  • Tumor stage, which describes the anatomic extent of disease, is a powerful determinant of prognosis and survival for patients with renal cell carcinoma (RCC).
  • Stratification of patients based on prognostic outcomes derived from staging systems facilitates therapeutic decision-making, disease surveillance, and clinical research.
  • Staging for RCC has evolved from the Robson classification into the TNM system, developed by the International Union Against Cancer and the American Joint Committee on Cancer.
  • The most recent revisions of the TNM system for RCC introduced in 1997 and 2002 further subdivided organ-confined tumors, reclassified tumors with venous involvement, and clarified the staging of tumors that invade the perisinus fat.
  • Nevertheless, additional modifications have been proposed that would alter the subclassification of organ-confined disease, integrate various levels of venous involvement with other aspects of local tumor aggressiveness, and upgrade the classification of adrenal involvement.
  • The data in support of each of these proposals will be discussed, and the current limitations of clinical and radiographic staging for RCC will be reviewed.
  • Finally, a glimpse into the future of staging of RCC will be offered with a discussion of integrated staging and prognostic systems.
  • [MeSH-major] Carcinoma, Renal Cell / pathology. Kidney Neoplasms / pathology. Neoplasm Staging / trends
  • [MeSH-minor] Biomarkers, Tumor / analysis. Forecasting. History, 20th Century. History, 21st Century. Humans. Prognosis. Renal Veins / physiopathology. Venous Thrombosis / physiopathology

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  • (PMID = 17239272.001).
  • [ISSN] 1558-7673
  • [Journal-full-title] Clinical genitourinary cancer
  • [ISO-abbreviation] Clin Genitourin Cancer
  • [Language] eng
  • [Publication-type] Historical Article; Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor
  • [Number-of-references] 94
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13. Siemer S, Lehmann J, Loch A, Becker F, Stein U, Schneider G, Ziegler M, Stöckle M: Current TNM classification of renal cell carcinoma evaluated: revising stage T3a. J Urol; 2005 Jan;173(1):33-7
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Current TNM classification of renal cell carcinoma evaluated: revising stage T3a.
  • PURPOSE: : Recent studies of rare cases of pT3a renal cell carcinoma extending directly into the adrenal gland showed worse survival than in other pT3a cases and recategorization as stage pT4 was suggested.
  • We assessed the prognostic validity of a stage pT3a diagnosis based on perirenal fat infiltration.
  • Focusing on pT3a tumors, as defined by perirenal fat infiltration, numerous clinical and histopathological parameters were investigated by univariate and multivariate statistical methods with cancer specific survival as the primary end point.
  • In patients with pT3a tumors tumor size was a significant parameter predicting survival.
  • The most significant cutoff value for tumor size in pT3a disease was 7 cm.
  • Therefore, to assess the prognostic value of the current T classification in regard to T3a tumors we excluded patients with tumor stage cM+ for further subgroup analysis.
  • Subsequently multivariate analysis in all 1,794 patients showed that modified T stage was an independent significant predictor of cancer specific survival.
  • Tumors directly infiltrating the adrenal gland should be reclassified as T4.
  • [MeSH-minor] Humans. Neoplasm Invasiveness. Neoplasm Staging. Nephrectomy. Prognosis. Retrospective Studies

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  • (PMID = 15592020.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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14. Jalón Monzón A, Alvarez Múgica M, Fernández Gómez JM, Martín Benito JL, Martínez Gómez F, García Rodríguez J, González Alvarez RC, Regadera Sejas FJ: [Renal cell carcinoma: prognostic factors and staging]. Arch Esp Urol; 2007 Mar;60(2):125-36
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  • [Title] [Renal cell carcinoma: prognostic factors and staging].
  • OBJECTIVES: To evaluate the prognostic significance of the 2002 TNM tumor classification for renal cell carcinoma, as well as other factors intervening in its survival.
  • Mean tumor size was 7.17 +/- 3.4 cm.
  • Most cases had a solitary tumor.
  • 8.2% of the patients had lymph node involvement at the time of diagnosis, and 8.6% metastases.
  • The number of months free of disease, the presence of metastatic lymph nodes, the treatment of the first recurrence and the presence of anemia were independent factors for cancer specific mortality.
  • CONCLUSIONS: The modification of the current classification of renal tumors pT3 and pT4 would help to a better decision-making in the therapy of tumors with vascular, perirenal fat or adrenal involvement.
  • Anemia and treatment of the first recurrence are important factors for cancer specific survival.
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Anemia / epidemiology. Anemia / etiology. Child. Disease-Free Survival. Female. Humans. Lymph Node Excision. Lymphatic Metastasis. Male. Middle Aged. Neoplasm Staging. Nephrectomy. Prognosis. Retrospective Studies. Spain / epidemiology. Survival Analysis. Tumor Burden

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  • (PMID = 17484480.001).
  • [ISSN] 0004-0614
  • [Journal-full-title] Archivos españoles de urología
  • [ISO-abbreviation] Arch. Esp. Urol.
  • [Language] spa
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Spain
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15. Ficarra V, Galfano A, Guillé F, Schips L, Tostain J, Mejean A, Lang H, Mulders P, De La Taille A, Chautard D, Descotes JL, Cindolo L, Novara G, Rioux-Leclercq N, Zattoni F, Artibani W, Patard JJ: A new staging system for locally advanced (pT3-4) renal cell carcinoma: a multicenter European study including 2,000 patients. J Urol; 2007 Aug;178(2):418-24; discussion 423-4
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] A new staging system for locally advanced (pT3-4) renal cell carcinoma: a multicenter European study including 2,000 patients.
  • PURPOSE: We provide an adequate prognostic stratification for locally advanced renal cell carcinoma and propose a new TNM classification.
  • Cancer specific survivals were estimated using the Kaplan-Meier method.
  • Five-year cancer specific survival was 60% for pT3a, 46.2% for pT3b, 10% for pT3c and 12% for pT4 tumors (p <0.0001).
  • According to median survival we identified 3 prognostic groups, including 1--patients with renal vein thrombosis (117 months), fat invasion (98 months) or infradiaphragmatic vena caval thrombosis (67 months), 2--patients with adrenal invasion alone (24 months), renal vein thrombosis plus fat invasion (24 months) or infradiaphragmatic vena cava plus fat invasion (24 months) and 3--patients with renal or infradiaphragmatic caval thrombosis plus adrenal involvement (11 months), supradiaphragmatic vena caval thrombosis (12 months) or Gerota's fascia invasion (12 months).
  • Five-year cancer specific survival rates in groups 1 to 3 were 61%, 35% and 12.9%, respectively (p <0.0001).
  • [MeSH-major] Carcinoma, Renal Cell / pathology. Kidney Neoplasms / pathology. Neoplasm Staging / methods
  • [MeSH-minor] Adrenal Glands / pathology. Aged. Europe. Female. Humans. Kaplan-Meier Estimate. Kidney / pathology. Lymphatic Metastasis / pathology. Male. Middle Aged. Multivariate Analysis. Neoplasm Invasiveness. Neoplastic Cells, Circulating. Nephrectomy. Prognosis. Renal Veins / pathology. Vena Cava, Inferior / pathology


16. Margulis V, Tamboli P, Matin SF, Meisner M, Swanson DA, Wood CG: Location of extrarenal tumor extension does not impact survival of patients with pT3a renal cell carcinoma. J Urol; 2007 Nov;178(5):1878-82
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  • [Title] Location of extrarenal tumor extension does not impact survival of patients with pT3a renal cell carcinoma.
  • PURPOSE: The current TNM classification for pathological pT3a renal cell carcinoma includes patients with perinephric or sinus fat invasion, suggesting that the prognoses are similar for these pathological findings.
  • However, sinus fat invasion was proposed by some investigators to be an independent predictor of inferior cancer specific outcome following surgical treatment.
  • To assess and improve the predictive ability of the current pT3a primary tumor classification we evaluated the prognostic significance of location of extrarenal tumor extension on cancer specific survival following surgery.
  • Patients with nonrenal cell carcinoma histology, direct adrenal invasion or a followup of less then 6 months were excluded from analyses.
  • There was no difference in 5-year cancer specific survival between 166 patients (45.5%) with SF invasion and 199 (54.5%) with PF invasion only (50.8% and 54.1%, p = 0.782 respectively).
  • On univariate analyses neither sinus fat invasion nor the location of extrarenal extension, assessed as perinephric fat vs sinus fat vs perinephric plus sinus fat, correlated with cancer specific survival following surgical treatment (HR 1.052, p = 0.783 and HR 1.072, p = 0.543, respectively).
  • After adjusting for the effects of nodal and systemic metastases tumor grade and sarcomatoid differentiation remained independent predictors of renal cell carcinoma specific survival in our pT3a cohort of patients (HR 1.508, p = 0.003 and HR 1.810, p = 0.018, respectively).
  • CONCLUSIONS: In contrast to previously reported observations, in our cohort of surgically treated patients with pT3a renal cell carcinoma the location of extrarenal extension was not an important prognosticator of cancer specific mortality.
  • Based on our findings we confirm that perinephric and/or sinus fat should be similarly subclassified in the primary tumor staging system.
  • [MeSH-minor] Female. Follow-Up Studies. Humans. Male. Middle Aged. Neoplasm Invasiveness. Neoplasm Staging. Nephrectomy / methods. Prognosis. Proportional Hazards Models. Retrospective Studies. Survival Rate / trends. Texas / epidemiology. Time Factors


17. Kirkali Z, Algaba F, Scarpelli M, Trias I, Selvaggi FP, Van Poppel H: What does the urologist expect from the pathologist (and what can the pathologists give) in reporting on adult kidney tumour specimens? Eur Urol; 2007 May;51(5):1194-201
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • OBJECTIVE: To identify the parameters required by the urologist to determine the prognosis and the treatment of renal cancer in adults, and to establish the potential therapeutic targets of the new treatments that started to show clinical efficacy.
  • METHODS: A literature search of the last 10 yr was done, paying specific attention to TNM 2002 (UICC staging) and Fuhrman's grading.
  • RESULTS: After the review of the literature, the opinion of the joint meeting including urologists and pathologists is that some aspects of the TNM 2002 classification must be refined.
  • The TNM 2002 classification is useful, but some adjustments should be made, particularly as referred to the tumour size cut-off, assessment of the invasion of the renal sinus fat tissue, and invasion of the ipsilateral adrenal gland.
  • [MeSH-minor] Humans. Neoplasm Invasiveness. Neoplasm Staging. Pathology, Clinical

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  • [CommentIn] Eur Urol. 2007 May;51(5):1166-8; discussion 1168-70 [17257741.001]
  • (PMID = 17125908.001).
  • [ISSN] 0302-2838
  • [Journal-full-title] European urology
  • [ISO-abbreviation] Eur. Urol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] Switzerland
  • [Number-of-references] 61
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18. Kebebew E, Reiff E, Duh QY, Clark OH, McMillan A: Extent of disease at presentation and outcome for adrenocortical carcinoma: have we made progress? World J Surg; 2006 May;30(5):872-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • BACKGROUND: Adrenocortical carcinoma (ACC), a rare and aggressive malignancy, accounts for up to 14% of adrenal incidentalomas.
  • The only chance of cure for ACC is diagnosis at an early stage; therefore, a main indication for adrenalectomy in patients with adrenal incidentaloma has been the potential risk of ACC.
  • Recent studies suggest that this has led to earlier stage of ACC at diagnosis, more curative operations, and better survival.
  • METHODS: We analyzed data on ACC from The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database.
  • The average tumor size was 12 cm (range: 2-36 cm), and only 4.2% were < or = 6 cm.
  • Most (88%) patients had surgical resection of their tumor, and external beam radiotherapy was used in only 12% of patients.
  • Between the time quartiles compared (as well as annually), there was no significant difference at presentation in age at diagnosis, sex, race/ethnicity, tumor size, tumor grade, the frequency of distant metastasis, and overall TNM stage.
  • Low tumor grade, lower stage of ACC, later time quartile, and surgical resection were associated with a lower cause-specific mortality by univariate analysis (P < or = 0.002) and by multivariate analysis (P < or = 0.031).
  • CONCLUSIONS: Although adrenal incidentalomas have become a common indication for adrenalectomy, this has not resulted in patients with ACC being diagnosed earlier or treated at a lower stage of disease at the national level.
  • The most important predictors of survival in these patients are tumor grade, tumor stage, and surgical resection.
  • [MeSH-major] Adrenal Cortex Neoplasms / surgery. Adrenalectomy. Adrenocortical Carcinoma / surgery
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Child. Child, Preschool. Cohort Studies. Female. Humans. Infant. Male. Middle Aged. Neoplasm Staging. Radiotherapy, Adjuvant. Retrospective Studies. SEER Program. Treatment Outcome. United States / epidemiology

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  • (PMID = 16680602.001).
  • [ISSN] 0364-2313
  • [Journal-full-title] World journal of surgery
  • [ISO-abbreviation] World J Surg
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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19. Goel MC, Mohammadi Y, Sethi AS, Brown JA, Sundaram CP: Pathologic upstaging after laparoscopic radical nephrectomy. J Endourol; 2008 Oct;22(10):2257-61
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • OBJECTIVE: Accurate tumor staging in renal cancer is critical for prognostic projections, follow-up schedules, clinical trials and potential systemic therapies.
  • We studied patients undergoing laparoscopic radical nephrectomy (LRN) to determine the extent of upstaging on histopathology evaluation and correlated the clinical and pathology staging to determine the factors responsible for upstaging.
  • PATIENTS AND METHODS: A retrospective review of patients undergoing LRN for renal cell cancer was performed.
  • Clinical staging was determined by CT/MRI scan and/or related preoperative work up (using AJCC TNM staging criteria).
  • RESULTS: One hundred twenty three patients qualified for the study; mean age was 62.14+/-13.6 years, M:F ratio was 60:63 and mean tumor size of 5.3+/-2.0 cm.
  • Upstaging was due to change in tumor size in 12, renal sinus fat involvement in 8, renal or adrenal vein involvement in 14, focal perirenal fat involvement in 6, and focal renal capsule penetration in 4 patients.
  • Mean tumor size was 5.3+/-2 cms at clinical, and 5.0+/-2.6 cms at pathology staging (P=NS).
  • 5 patients had LN metastasis detected with tumor size of 5.5, 5.6, 6.8, and 7.2 cms in diameter, and one patient with LN metastasis was T1a stage (3.2 cm).
  • Renal vein/inferior venal cava/adrenal vein was involved in 14 patients, adrenal was involved in 21 patients and renal sinus was involved in 19/123 patients.
  • CONCLUSIONS: Pathologic upstaging of malignant renal neoplasms occurred in about 31% of patients following LRN.
  • Down staging was less common and mean tumor size does not significantly change.

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  • (PMID = 18937590.001).
  • [ISSN] 1557-900X
  • [Journal-full-title] Journal of endourology
  • [ISO-abbreviation] J. Endourol.
  • [Language] ENG
  • [Publication-type] Journal Article
  • [Publication-country] United States
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20. Thompson RH, Leibovich BC, Cheville JC, Webster WS, Lohse CM, Kwon ED, Frank I, Zincke H, Blute ML: Is renal sinus fat invasion the same as perinephric fat invasion for pT3a renal cell carcinoma? J Urol; 2005 Oct;174(4 Pt 1):1218-21
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • PURPOSE: Perinephric and renal sinus fat invasion are classified as pT3a renal cell carcinoma (RCC) according to the 2002 American Joint Committee on Cancer.
  • MATERIALS AND METHODS: Between 1970 and 2002, 205 patients without direct adrenal invasion underwent nephrectomy for pT3a clear cell RCC.
  • External validation is needed before suggesting a change to the TNM staging system.
  • [MeSH-minor] Adipose Tissue / pathology. Adrenal Glands / pathology. Aged. Female. Humans. Lymphatic Metastasis. Male. Middle Aged. Multivariate Analysis. Neoplasm Invasiveness. Neoplasm Staging. Prognosis

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  • [CommentIn] Adv Anat Pathol. 2007 Mar;14(2):63-8 [17471114.001]
  • (PMID = 16145373.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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21. Bertini R, Roscigno M, Freschi M, Strada E, Petralia G, Pasta A, Matloob R, Sozzi F, Da Pozzo L, Colombo R, Guazzoni G, Doglioni C, Montorsi F, Rigatti P: Renal sinus fat invasion in pT3a clear cell renal cell carcinoma affects outcomes of patients without nodal involvement or distant metastases. J Urol; 2009 May;181(5):2027-32
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • PURPOSE: According to the 2002 American Joint Committee on Cancer TNM classification, perinephric and renal sinus fat invasion are classified as pT3a renal cell carcinoma.
  • We analyzed the impact of sinus fat invasion on cancer specific survival in a cohort of patients with pT3a clear cell renal cell carcinoma.
  • The prognostic role of sinus fat invasion in cancer specific survival was assessed by Cox proportional hazards regression models.
  • RESULTS: Ten patients had direct ipsilateral adrenal invasion and were excluded from analysis.
  • In the overall population sinus fat invasion did not reach independent predictive status in terms of cancer specific survival on multivariate Cox regression analysis after adjusting for age, performance status, tumor dimension, tumor grade, synchronous metastases, nodal involvement, sarcomatoid differentiation and coagulative necrosis.
  • In the subset of patients with pNx/pN0 M0 (83) the actuarial 5-year cancer specific survival was 71.9% and 45.5% for those with perinephric fat invasion only and sinus fat invasion, respectively (p = 0.025).
  • CONCLUSIONS: Sinus fat invasion in clear cell renal cell carcinoma significantly affects cancer specific survival in patients without nodal or distant metastases.
  • However, sinus fat invasion is not associated with worse cancer specific survival in cases of metastatic disease.
  • [MeSH-major] Adipose Tissue / pathology. Carcinoma, Renal Cell / mortality. Carcinoma, Renal Cell / pathology. Kidney Neoplasms / mortality. Kidney Neoplasms / pathology. Neoplasm Invasiveness / pathology
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Analysis of Variance. Cohort Studies. Disease-Free Survival. Female. Humans. Kidney Pelvis / pathology. Lymph Nodes / pathology. Male. Middle Aged. Multivariate Analysis. Neoplasm Staging. Probability. Prognosis. Proportional Hazards Models. Retrospective Studies. Survival Analysis






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