An Independent Validation of 2010 Tumor-Node-Metastasis Classification for Renal Cell Carcinoma: A Multi-center Study by the Urooncology Association of Turkey Renal Cancer-Study Group
Journal Title: JOURNAL OF UROLOGICAL SURGERY - Year 2017, Vol 4, Issue 2
Abstract
Objective: The American Joint Committee on Cancer tumor-node-metastasis (TNM) classification has been updated by the 7th edition in 2010. The objective of the study was to evaluate cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC) and assess the concordance of 2002 and novel 2010 TNM primary tumor classifications. Materials and Methods: A retrospective analysis of RCC registries from 25 institutions of the Urooncology Association of Turkey Renal Cancer-Study Group was performed. Patients with RCC had a radical or partial nephrectomy. The database consisted of 1889 patients. Results: Median follow-up time was 25 months (interquartile range: 11.2-47.8). The 5-year CSS rate for pT1a, pT1b, pT2a, pT2b, pT3a and pT4 tumors were 97% [95% confidence interval (CI): 0.93-0.99], 94% (95% CI: 0.91-0.97), 88% (95% CI: 0.81-0.93), 77% (95% CI: 0.64-0.86) 74% (95% CI: 0.65-0.81) and 66% (95% CI: 0.51-0.77), respectively according to the 2010 TNM classification (p<0.001). CSS comparisons between pT1a-pT1b (p=0.022), pT1b-pT2a (p=0.030), pT3a-pT3b (p<0.001) and pT3b-pT4 (p=0.020) were statistically significant. Conversely, pT2a-pT2b (p=0.070) and pT2b-pT3a (p=0.314) were not statistically significant. Multivariable analyses revealed the pT stage in the 2010 TNM classification as an independent prognostic factor for CSS (p for trend=0.002). C-indexes for 2002 and 2010 TNM classifications were 0.8683 and 0.8706, respectively. Conclusion: Subdividing pT2 does not have a CSS advantage. Moving adrenal involvement to pT4 yielded a more accurate prognosis prediction. T stage and LNI are independent prognostic factors for CSS in RCC. Overall, the novel 2010 TNM classification is slightly improved over the former one. However, shown by C-index values, this improvement is not sufficient to state that 2010 TNM outperforms the 2002 TNM.
Authors and Affiliations
Tayyar Alp Özkan, Saadettin Eskiçorapçı, Özgür Yaycıoğlu, Bülent Akdoğan, Çağatay Göğüs, Ayhan Dirim, Cavit Can, Asıf Yıldırım, Haluk Özen, Levent Türkeri, Urooncology Association of Turkey Renal Cancer-Study Group Urooncology Association of Turkey Renal Cancer-Study Group
Keywords
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- DOI 10.4274/jus.1369
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