Scroll Up
Scroll Down
Play Play Play Play
Unregistered User
Click here if this is not your Personal Edition
 
Contact Us | Free E-Mail Updates | Journals | Register a colleague
 
 
Renal Cancer
 
   
 
SEARCH   
Doctor's Guide Free CME
Medline
Congress Resource Centre
 

 EXPLORE :
   Most Read News
 All News  All News
 All Webcasts / CME  All Webcasts / CME
 All Cases  All Cases
 Congress Resource Centre  Congress Resource Centre
 All Medical Resources  All Medical Resources
 Medical  My Personal Edition



Warning | Privacy

 

 
 Recent news - Renal Cancer
    TopAbstracts in Renal Cancer 11/25/2009 - (DGNews)
    Recipient, Donor Race May Affect Mortality in Kidney Transplantation - (DGNews)
    TopAbstracts in Renal Cancer 11/11/2009 - (DGNews)
    TopAbstracts in Renal Cancer 10/28/2009 - (DGNews)
    FDA Approves Pazopanib for Advanced Renal Cell Carcinoma - (DGNews)

    News archive

     Recent webcasts/CME - Renal Cancer

    Webcasts/CME archive

     Recent cases - Renal Cancer
      Synchronous Lingual and Thyroid Metastasis from Renal Cell Carcinoma
      Granulocytosis and Thrombocytosis in Renal Cell Carcinoma: A Pro-Inflammatory Cytokine Response Originating in the Tumour
      Xp11.2 Translocation Renal Cell Carcinoma Occurring During Pregnancy with a Novel Translocation Involving Chromosome 19: A Case Report with Review of the Literature
      Stauffer's Syndrome as a Prominent Manifestation of Renal Cancer: A Case Report
      Oral Cavity Metastasis of Renal Cell Carcinoma: A Case Report

      Cases archive
        




      my personal edition > renal cancer > news
      divider

        E-Mail this DGReview to a colleague

      DGReview


      Guideline for Cutoff Size For Stage I Renal Cell Carcinoma Should Be Lowered

      A DGReview of :"Reassessment of the 1997 TNM classification system for renal cell carcinoma"
      Cancer

      12/04/2003
      By Emma Hitt, PhD


      The Tumor, Nodes, Metastases (TNM) cutoff of 7.0 cm used to separate Stage I from Stage II renal cell carcinoma (RCC) appears to be too high, according to a new report. Instead, a 5.0 cm cutoff appears to stratify size-related survival difference more accurately.

      In 1997, the TNM classification of malignant tumour size cutoff between T1 and T2 organ-confined RCC was changed from 2.5 cm to 7.0 cm; however, several investigators have claimed that 7.0 cm may be too high.

      Therefore, James M. Elmore, MD, with the University of Texas Southwestern Medical Center, Dallas, United States, and colleagues evaluated the validity of this cutoff size by assessing the survival of patients with Stage I RCC according to a series of alternative size cutoff values. They also determined how these size cutoffs affected the risk of having nonorgan-confined tumours, regional lymph node involvement, and metastatic disease.

      The researchers evaluated a database containing the records of 1,324 patients with RCC who underwent open radical nephrectomy between 1960 and 1991. Patients with Stage I disease were stratified by size cutoffs ranging from 2.5 to 7.0 cm in 0.5-cm increments.

      A total of 351 out of 544 evaluable patients had tumours of 7.0 cm or smaller, and 233 of these patients had 1997 Stage I (T1N0M0) disease.

      When patients with 1997 Stage I tumours were separated based on tumour size, a 5.0-cm cutoff resulted in the most difference in survivals. The 5-year DSS rates for patients with Stage I tumours 5 cm or smaller versus those with tumours measuring 5.1-7 cm were 94.6% versus 79.2% (P = .003). Furthermore, the survival of patients with Stage I RCC lesions measuring 5.1-7.0 cm was the same as for patients with 1997 Stage II (T2N0M0) RCC.

      The difference in probability of having local nonorgan-confined disease was also greatest with a 5.0 cm cutoff value (present in 16.2% of the patients with tumours smaller than 5.0 cm compared with 36.8% of the patients with tumours measuring 5.1-7.0 cm in size), which may have an impact on nephron-sparing surgery in selected patients, the authors note.

      The difference in the probabilities of having lymph node-positive or metastatic disease did not change significantly using any of the cutoffs, although the probability of both of these increased with increasing tumour size, they report.

      "The current study findings, as well as those of others, support a size cutoff for Stage I RCC between 4 cm and 5 cm," the researchers conclude.

      Cancer 2003;98:2329-2334. "Reassessment of the 1997 TNM classification system for renal cell carcinoma"

      E-Mail this DGReview to a colleague   To print, use this version






      All contents Copyright (c) 1995-2009 Doctor's Guide Publishing Limited. All rights reserved.



      The NTK initiative. Physicians helping physicians identify Need-To-Know science
         Feedback
      Please rate this article: Strongly DISAGREE...Strongly AGREE NTK logo
      Question 1 - Physicians need to become aware of this information as soon as possible. Question 2 - This information is likely to have an impact on the way physicians practice medicine.
      1
      2
      3
      4
      5
      6
      7
      Send