A New Staging System for Locally Advanced (pT3–4) Renal Cell Carcinoma: A Multicenter European Study Including 2,000 Patients

PurposeWe provide an adequate prognostic stratification for locally advanced renal cell carcinoma and propose a new TNM classification.Materials and MethodsWe analyzed clinical and pathological data on a large series of patients undergoing radical nephrectomy for pT3–4 renal cell carcinoma at 12 European centers. Cancer specific survivals were estimated using the Kaplan-Meier method. The log rank test was used for comparing survival curves and for univariate analysis. The Cox proportional hazards regression model was used for multivariate analysis.ResultsThe analysis included 1,969 patients. Median survivor followup was 49 months. Five-year cancer specific survival was 60% for pT3a, 46.2% for pT3b, 10% for pT3c and 12% for pT4 tumors (p <0.0001). According to median survival we identified 3 prognostic groups, including 1—patients with renal vein thrombosis (117 months), fat invasion (98 months) or infradiaphragmatic vena caval thrombosis (67 months), 2—patients with adrenal invasion alone (24 months), renal vein thrombosis plus fat invasion (24 months) or infradiaphragmatic vena cava plus fat invasion (24 months) and 3—patients with renal or infradiaphragmatic caval thrombosis plus adrenal involvement (11 months), supradiaphragmatic vena caval thrombosis (12 months) or Gerota’s fascia invasion (12 months). Five-year cancer specific survival rates in groups 1 to 3 were 61%, 35% and 12.9%, respectively (p <0.0001). On multivariate analysis the proposed classification had an independent prognostic value.ConclusionsOur results suggest the necessity of reclassifying locally advanced renal cell carcinoma according to the 3 described prognostic categories.