Presence of Tumor Necrosis is Not a Significant Predictor of Survival in Clear Cell Renal Cell Carcinoma: Higher Prognostic Accuracy of Extent Based Rather Than Presence/Absence Classification

Tumor necrosis is an adverse prognostic factor in clear cell renal cell carcinoma but prospective evaluation of necrosis on a presence/absence basis shows that it does not provide independent prognostic information. The predictive accuracy of an extent based classification is superior and is retained as an independent prognostic factor. We recommend the scoring of necrosis according to its extent with further subclassification based on a 20% cutoff.