The Influence of Clinical and Pathological Stage Discrepancy on Cancer Specific Survival in Patients Treated for Renal Cell Carcinoma

Robert S. Svatek, Yair Lotan, Michael Hermann, David A. Duchene, Arthur I Sagalowsky, Jeffrey A Cadeddu

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Abstract

Purpose: We compared clinical and pathological staging in a contemporary, consecutive series of patients treated with partial or radical nephrectomy for renal cell carcinoma and we determined the effect of clinical and pathological stage discrepancy on outcomes. Materials and Methods: We collected retrospective clinical, pathological and survival data on 264 consecutive patients with clinical T1-3 renal cell carcinoma who were treated with laparoscopic or open partial or radical nephrectomy at a single institution from 1994 to 2003. Results: Pathological up staging occurred in 44 of 264 patients (17%) patients. Of 135 clinical T1 tumors 25 (18.5%) and 18 of 85 (21.2%) clinical T2 tumors were pathologically up staged. Patients with clinical T1 and T2 tumors were stratified into 2 groups, including those with the same clinical and pathological stage, and those with pathological up staging. Mean 5-year recurrence-free survival ± SD for same stage vs pathologically up staged clinical T1 (84.3% ± 4.4% vs 47.4% ± 11.5%) and clinical T2 (80.0% ± 6.8% vs 40.7% ± 13.4%) tumors was significantly different (p <0.0002). Five-year cancer specific survival for same stage vs pathologically up staged clinical T1 tumors was significantly different (98.5% ± 1.5% vs 69.7% ± 11.3%, p = 0.0005), while that for clinical T2 tumors approached clinical significance (90.9% ± 5.0% vs 72.7% ± 13.4%, p = 0.0501). Conclusions: Stage discrepancy is common in surgically treated patients diagnosed with renal masses and it has a significant impact on clinical outcome. Implications of such clinical and pathological stage discrepancy should be considered when counseling patients and determining therapeutic approaches.

Original languageEnglish (US)
Pages (from-to)1321-1325
Number of pages5
JournalJournal of Urology
Volume176
Issue number4
DOIs
StatePublished - Oct 2006

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Renal Cell Carcinoma
Survival
Neoplasms
Nephrectomy
Counseling
Kidney
Recurrence

Keywords

  • carcinoma
  • kidney
  • kidney neoplasms
  • mortality
  • neoplasm recurrence
  • renal cell

ASJC Scopus subject areas

  • Urology

Cite this

The Influence of Clinical and Pathological Stage Discrepancy on Cancer Specific Survival in Patients Treated for Renal Cell Carcinoma. / Svatek, Robert S.; Lotan, Yair; Hermann, Michael; Duchene, David A.; Sagalowsky, Arthur I; Cadeddu, Jeffrey A.

In: Journal of Urology, Vol. 176, No. 4, 10.2006, p. 1321-1325.

Research output: Contribution to journalArticle

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title = "The Influence of Clinical and Pathological Stage Discrepancy on Cancer Specific Survival in Patients Treated for Renal Cell Carcinoma",
abstract = "Purpose: We compared clinical and pathological staging in a contemporary, consecutive series of patients treated with partial or radical nephrectomy for renal cell carcinoma and we determined the effect of clinical and pathological stage discrepancy on outcomes. Materials and Methods: We collected retrospective clinical, pathological and survival data on 264 consecutive patients with clinical T1-3 renal cell carcinoma who were treated with laparoscopic or open partial or radical nephrectomy at a single institution from 1994 to 2003. Results: Pathological up staging occurred in 44 of 264 patients (17{\%}) patients. Of 135 clinical T1 tumors 25 (18.5{\%}) and 18 of 85 (21.2{\%}) clinical T2 tumors were pathologically up staged. Patients with clinical T1 and T2 tumors were stratified into 2 groups, including those with the same clinical and pathological stage, and those with pathological up staging. Mean 5-year recurrence-free survival ± SD for same stage vs pathologically up staged clinical T1 (84.3{\%} ± 4.4{\%} vs 47.4{\%} ± 11.5{\%}) and clinical T2 (80.0{\%} ± 6.8{\%} vs 40.7{\%} ± 13.4{\%}) tumors was significantly different (p <0.0002). Five-year cancer specific survival for same stage vs pathologically up staged clinical T1 tumors was significantly different (98.5{\%} ± 1.5{\%} vs 69.7{\%} ± 11.3{\%}, p = 0.0005), while that for clinical T2 tumors approached clinical significance (90.9{\%} ± 5.0{\%} vs 72.7{\%} ± 13.4{\%}, p = 0.0501). Conclusions: Stage discrepancy is common in surgically treated patients diagnosed with renal masses and it has a significant impact on clinical outcome. Implications of such clinical and pathological stage discrepancy should be considered when counseling patients and determining therapeutic approaches.",
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AU - Sagalowsky, Arthur I

AU - Cadeddu, Jeffrey A

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N2 - Purpose: We compared clinical and pathological staging in a contemporary, consecutive series of patients treated with partial or radical nephrectomy for renal cell carcinoma and we determined the effect of clinical and pathological stage discrepancy on outcomes. Materials and Methods: We collected retrospective clinical, pathological and survival data on 264 consecutive patients with clinical T1-3 renal cell carcinoma who were treated with laparoscopic or open partial or radical nephrectomy at a single institution from 1994 to 2003. Results: Pathological up staging occurred in 44 of 264 patients (17%) patients. Of 135 clinical T1 tumors 25 (18.5%) and 18 of 85 (21.2%) clinical T2 tumors were pathologically up staged. Patients with clinical T1 and T2 tumors were stratified into 2 groups, including those with the same clinical and pathological stage, and those with pathological up staging. Mean 5-year recurrence-free survival ± SD for same stage vs pathologically up staged clinical T1 (84.3% ± 4.4% vs 47.4% ± 11.5%) and clinical T2 (80.0% ± 6.8% vs 40.7% ± 13.4%) tumors was significantly different (p <0.0002). Five-year cancer specific survival for same stage vs pathologically up staged clinical T1 tumors was significantly different (98.5% ± 1.5% vs 69.7% ± 11.3%, p = 0.0005), while that for clinical T2 tumors approached clinical significance (90.9% ± 5.0% vs 72.7% ± 13.4%, p = 0.0501). Conclusions: Stage discrepancy is common in surgically treated patients diagnosed with renal masses and it has a significant impact on clinical outcome. Implications of such clinical and pathological stage discrepancy should be considered when counseling patients and determining therapeutic approaches.

AB - Purpose: We compared clinical and pathological staging in a contemporary, consecutive series of patients treated with partial or radical nephrectomy for renal cell carcinoma and we determined the effect of clinical and pathological stage discrepancy on outcomes. Materials and Methods: We collected retrospective clinical, pathological and survival data on 264 consecutive patients with clinical T1-3 renal cell carcinoma who were treated with laparoscopic or open partial or radical nephrectomy at a single institution from 1994 to 2003. Results: Pathological up staging occurred in 44 of 264 patients (17%) patients. Of 135 clinical T1 tumors 25 (18.5%) and 18 of 85 (21.2%) clinical T2 tumors were pathologically up staged. Patients with clinical T1 and T2 tumors were stratified into 2 groups, including those with the same clinical and pathological stage, and those with pathological up staging. Mean 5-year recurrence-free survival ± SD for same stage vs pathologically up staged clinical T1 (84.3% ± 4.4% vs 47.4% ± 11.5%) and clinical T2 (80.0% ± 6.8% vs 40.7% ± 13.4%) tumors was significantly different (p <0.0002). Five-year cancer specific survival for same stage vs pathologically up staged clinical T1 tumors was significantly different (98.5% ± 1.5% vs 69.7% ± 11.3%, p = 0.0005), while that for clinical T2 tumors approached clinical significance (90.9% ± 5.0% vs 72.7% ± 13.4%, p = 0.0501). Conclusions: Stage discrepancy is common in surgically treated patients diagnosed with renal masses and it has a significant impact on clinical outcome. Implications of such clinical and pathological stage discrepancy should be considered when counseling patients and determining therapeutic approaches.

KW - carcinoma

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KW - kidney neoplasms

KW - mortality

KW - neoplasm recurrence

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