title: Tumor size improves the accuracy of TNM predictions in patients with renal cancer.
abstract: OBJECTIVE
  Current staging for renal cancer (RC) does not directly rely on tumor size. We examined the increment in accuracy related to inclusion of pathologically determined tumor size in prediction of nodal metastases (N+), distant metastases (M+), and cancer-specific survival (CSS).
  
  
  METHODS
  Partial or radical nephrectomy was performed in 2245 patients with clear cell histology. Pathologic stages were T1a in 566, T1b in 490, T2 in 303, T3 in 831, and T4 in 55 patients. Tumor size was 0.5-25 cm (mean, 6.8). Multivariate models relied on 1997 and 2002 TNM variables and addressed N+, M+ disease, and CCS. Their accuracy was compared according to either the presence or absence of tumor size.
  
  
  RESULTS
  In all univariate and multivariate models, tumor size was a statistically significant predictor of all outcomes (p< or =0.001). In all multivariate models, tumor size added between 3.7% and 0.8% to predictive accuracy of either 1997 or 2002 TNM categories.
  
  
  CONCLUSIONS
  Tumor size represents a highly significant, multivariate, and informative predictor of RC outcomes and may warrant inclusion in future TNM revisions.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Que., Canada. pierre.karakiewicz@umontreal.ca
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lewinshtein
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Francois
authors.initials: F
authors.lastname: Guille
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Bernard
authors.initials: B
authors.lastname: Lobel
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Jacques
authors.initials: J
authors.lastname: Tostain
authors.forename: Clement-Claude
authors.initials: CC
authors.lastname: Abbou
authors.forename: Dominique
authors.initials: D
authors.lastname: Chopin
authors.forename: Alexandre
authors.initials: A
authors.lastname: De La Taille
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
mesh_terms: D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D006801:Humans; D007668:Kidney / Q000473:pathology; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008954:Models, Biological; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009367:Neoplasm Staging / Q000379:methods*; D009929:Organ Size; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D016019:Survival Analysis