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Lee, Chang, and Jeon: Optimal Size Cutoff Point for Prognostic Stratification of Localized Renal Cell Carcinoma
Original Article

Korean J Urol 2006;47(6):601-606.

Published online: 18 December 2006

DOI: https://doi.org/10.4111/kju.2006.47.6.601

Optimal Size Cutoff Point for Prognostic Stratification of Localized Renal Cell Carcinoma

Dong-Gi Lee, Sung-Goo Chang, Seung Hyun Jeon

1From the Department of Urology School of Medicine, Kyung Hee University, Seoul, Korea

Corresponding author: Jeon Seung-hyun Kyunghee University College of Medicine Department of Urology Kyunghee University Dongseo Medical Hospital urology 149 Sangil-dong, Gangdong-gu, Seoul ? 134-090 TEL: 02-440-6161 FAX: 02-440-6295 E-mail: juro@khnmc.or.kr

Received 23 January 2006       Accepted 9 March 2006

Copyright © 2006 The Korean Urological Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purpose of this study was to evaluate the validity of the cutoff size for a localized renal cell carcinoma (RCC) by assessing the survival of RCC patients according to a series of alternative size cutoff values.

Materials and Methods:

The outcomes of 147 patients with localized RCC, treated by radical nephrectomy at our institution, between 1984 and 2004, were retrospectively evaluated. The mean follow-up period was 54.9±32.5 months. The survival of patients with tumors smaller than a specified size cutoff was compared with that of tumors larger than the cutoff, and the most discriminating cutoff identified.

Results:

114 and 33 patients were pT1 (77.6%) and pT2 (22.4%), respectively. There were 10 recurrences (8.8%) and 6 deaths (5.3%) in the pT1 group, and 8 recurrences (24.2%) and 8 deaths (24.2%) in the pT2 group. The differences in survival were maximized when the tumor size cutoff point was 7cm (cancer-specific survival rate: 92.0% vs. 71.5% p=0.0003, diseasefree survival rate: 88.5% vs. 69.1% p=0.0092). The next significant difference was observed with a cutoff of 4cm (cancer-specific survival rate: 96.0% vs. 83.7% p=0.0467, disease-free survival rate: 96.0% vs. 78.8% p= 0.0121).

Conclusions:

Tumor size is an important prognostic factor in patients with an organ confined RCC. The established cutoff point of 7cm provided reasonable prognostic differences. A 4cm cutoff point is also feasible for separating groups with different survivals after a nephrectomy. Hence, the T1a/1b/T2 classification system is practical for the division of localized RCC. (Korean J Urol 2006;47:601-606)

Keywords: Renal cell carcinoma, Neoplasm staging, Neoplasms

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Fig. 1.
Cancer-specific survival curves and 5 year survival rates (5YRS).
kju-47-601f1.tif
Table 1.
Patient characteristics
Characteristics η %
Sex (Male:Female) 100:47 66:32
Age (years) 55±12  
Stage (TNM, 1997)    
  T1 114 77.6
  T2 33 22.4
Histologic type
  Conventional 126 85.7
  Papillary 11 7.5
  Chromophobe 10 6.8
Nuclear grade (Fuhrman system)
  Low grade (Gr 1+2) 84 57.1
  High grade (Gr 3+4) 63 42.9
Symptom (+) 38 25.9
Microvascular invasion (+) 22 15.0
Table 2.
Disease recurrence site in T1 and T2
  T1 T2
n % n %
Recurrence rate 10/114 16.6 8/33 23.5
Recurrence site
  Lung 5 50.0 7 87.5
  Liver 3 30.0 1 12.5
  Adrenal gland 2 20.0 0 0.0
  Pleura 1 10.0 0 0.0
  Bone 1 10.0 1 12.5
  Brain 0 0.0 1 12.5
Table 3.
Cancer specific survival and disease free survival according to tumor size
Cutoff size (cm) Cancer-specific survival Disease-free survival
5YRS (%)∗ p-value† 5YRS (%)∗ p-value†
≤2.5 100.0 0.2168 100.0 0.1392
>2.5 86.3 82.5
≤3 100.0 0.0935 100.0 0.0458
>3 85.3 81.2
≤4 96.0 0.0467 96.0 0.0121
>4 83.7 78.8
<5 90.8 0.0978 88.8 0.1399
>5 83.9 79.9
<6 91.1 0.0168 88.1 0.0680
>6 80.6 77.6
≤7 92.0 0.0003 88.5 0.0091
>7 71.5 69.1
≤8 89.6 0.0263 86.4 0.1289
>8 76.4 72.2

5YRS: 5 year survival rates, ∗: calculated by Kaplan-Meier method, †: log rank test

Table 4.
Univariate analysis of prognostic factors
Factor Cancer-specific survival Disease-free survival
Log rank value p-values∗ Log rank value p-values∗
Sex 0.12 0.6452 0.00 0.9661
Cell type 1.42 0.6452 0.31 0.8560
Nuclear grade 5.84 0.1199 6.16 0.1043
Microvascular invasion 1.27 0.2601 7.43 0.0064
Present symptom 3.13 0.0769 7.69 0.0056
4cm cutoff size 3.13 0.0769 7.69 0.0056
7cm cutoff size 13.31 0.0467 6.30 0.0121

∗: log rank test

Table 5.
Relationships between tumor size and other prognostic factors evaluated at 4 and 5cm cutoff points
Factor 4cm cutoff point 7cm cutoff point
≤4cm >4cm p-value∗ ≤7cm >7cm p-value∗
n(%) n(%) n(%) n(%)
Microvascular invasion (+) 2 (3.8) 20 (21.1) 0.005 15 (13.3) 7 (20.6) 0.295
Symptom (+) 7 (13.5) 31 (32.6) 0.011 24 (21.2) 14 (41.2) 0.020
Total 52 95   113 34  

∗Pearson chi-square test

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