[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.

METHODS

Retrospective chart review of 316 renal carcinomas operated between 1970 and 2003. Twenty-five prognostic variables were analyzed.

RESULTS

The histological type was renal cell carcinoma in 90.5% of the patients. Most tumors were T1b or T2, with a Fuhrman nuclear grade I or II. 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 most frequent clinical presentations were hematuria and/or pain. Mean follow-up was 57.8 months. 24.1% of the cases had recurrence, more than 50% of them during the first year. Advanced tumors (T3, T4) had the tendency to have a nuclear grade III-IV, bigger size, necrosis, vascular involvement, lymph node involvement, and metastases. At the end of follow-up, most patients were alive and disease free. 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.