Prognostic factors in renal cancer.

In conclusion, the accumulated data indicate that the local extent of a renal carcinoma at the time of surgical intervention is the most important single variable in determining survival. Nuclear grade and cell type of the tumor appear to be of additional prognostic value, especially in patients whose tumor has spread beyond the anatomic confines of the kidney, because these variables may reflect the biologic virulence of the particular tumor in the individual host. Nuclear morphometry and cellular DNA content may play a more important role in the future by identifying that population of patients with clinically localized disease in whom radical nephrectomy will not be not curative, presumably because of concurrent undetectable micrometastases. This distinction will become increasingly important as more effective adjuvant therapies are identified.