Prognostic indicators for renal cell carcinoma: A multivariate analysis of643 patients using the revised 1997 TNM staging criteria

Purpose: We determine independent prognostic indicators for renal cell carc inoma using the revised 1997 TNM staging criteria. Materials and Methods: The records of 643 consecutive patients undergoing p artial or radical nephrectomy at our institution between 1987 and 1998 were reviewed. Preoperative evaluation of functional status using the Eastern C ooperative Oncology Group (ECOG) criteria was performed in all cases. Renal cell carcinoma grade and stage were evaluated using the 1997 American Join t Committee on Cancer grading and TNM staging criteria, respectively. Patie nts were followed for a mean plus or minus standard deviation of 47 +/- 40 months (median 87). Kaplan-Meier survival curves were used to determine 5-y ear cancer specific survival for all patient groups. Univariate analysis us ing log rank sum tests was performed to evaluate the prognostic significanc e of overall TNM stage, tumor stage, disease grade and ECOG status. Multiva riate analysis was performed to determine which factors had an independent impact on survival of patients with renal cell carcinoma. Results: The 5-year cancer specific survival rate was 91%, 74%, 67% and 32% for TNM stages I, II, III and IV lesions, respectively (p <0.001). Analysi s demonstrated a survival rate of 83% for stage T1, 51% for stage T2, 42% f or stage T3 and 28% for stage T4 disease (p <0.001), and 89% for grade 1, 6 5% for grade 2, and 46% for grades 3 and 4 (p <0.001). Multivariate analysi s revealed that overall TNM stage and grade of disease were the most import ant prognostic indicators for renal cell carcinoma (p <0.001). ECOG classif ication was a less significant predictor (p = 0.031) and tumor stage was no t shown to have any independent impact on patient survival(p = 0.138). Conclusions: Better survival rates of patients with localized and advanced renal cell carcinoma can be demonstrated with recent advances in diagnosis and treatment. The revised 1997 TNM criteria manifest an appropriate adjust ment in staging renal eel carcinoma based on these improvements, with overa ll stage correlating with cancer specific survival. In contrast, while effe ctively predicting survival, tumor stage did not demonstrate an independent impact on renal cell carcinoma prognosis under multivariate analysis. Inst ead, other factors, such as ECOG status and more importantly grade of disea se, appeared to affect survival significantly as independent elements. Base d on our recent experience with patients treated for renal cell carcinoma i n the era of enhanced technology and improved survival, tumor grade and mol ecular markers may serve as useful adjuncts to TNM staging in guiding treat ment and predicting survival outcomes.