Significant Discrepancy Between Clinical And Pathologic Staging In Renal Cell Carcinoma

The treatment algorithm for renal cancer is largely based on the accuracy and reliability of radiographic imaging. The value of preoperative radiographic staging is even more important in the follow-up of patients with renal cancer who undergo laparoscopic nephrectomy with morcellation due to the lack of precise pathologic staging.

In the October issue of the Journal of Urology, Svatek and colleagues from the University of Texas - Southwestern report the incidence of pathologic upstaging in a series of patients with surgically treated kidney cancer.

Of 264 patients, upstaging occurred in 17% of patients, including 18.5% of those with T1 tumors and 21% of clinical stage T2 tumors. In addition, there was a statistically significant difference in the 5-year recurrence-free survival between patients with T1 tumors that were not upstaged (84.3%) vs. 47.4% of those that were upstaged (p < 0.0002). A similar difference was seen in disease specific survival (98% vs. 69.7%, p < 0.006).

These data suggest that nearly 20% of patients with clinical stage T1 tumors may be upstaged after nephrectomy. The observed differences in recurrence-free survival and disease-specific survival provide additional evidence supporting intact specimen extraction after laparoscopic nephrectomy in cases of suspected malignancy.

Svatek RS, Lotan Y, Hermann M, Duchene DA, Sagalowsky AI, Cadeddu JA

J Urol. 2006 Oct;176(4 Pt 1):1321-5
Reviewd By UroToday.com Contributing Editor Ricardo F. Sánchez-Ortiz, MD