title: The influence of clinical and pathological stage discrepancy on cancer specific survival in patients treated for renal cell carcinoma.
abstract: OBJECTIVE
  We compared clinical and pathological staging in a contemporary, consecutive series of patients treated with partial or radical nephrectomy for renal cell carcinoma and we determined the effect of clinical and pathological stage discrepancy on outcomes.
  
  
  METHODS
  We collected retrospective clinical, pathological and survival data on 264 consecutive patients with clinical T1-3 renal cell carcinoma who were treated with laparoscopic or open partial or radical nephrectomy at a single institution from 1994 to 2003.
  
  
  RESULTS
  Pathological up staging occurred in 44 of 264 patients (17%) patients. Of 135 clinical T1 tumors 25 (18.5%) and 18 of 85 (21.2%) clinical T2 tumors were pathologically up staged. Patients with clinical T1 and T2 tumors were stratified into 2 groups, including those with the same clinical and pathological stage, and those with pathological up staging. Mean 5-year recurrence-free survival +/- SD for same stage vs pathologically up staged clinical T1 (84.3% +/- 4.4% vs 47.4% +/- 11.5%) and clinical T2 (80.0% +/- 6.8% vs 40.7% +/- 13.4%) tumors was significantly different (p < 0.0002). Five-year cancer specific survival for same stage vs pathologically up staged clinical T1 tumors was significantly different (98.5% +/- 1.5% vs 69.7% +/- 11.3%, p = 0.0005), while that for clinical T2 tumors approached clinical significance (90.9% +/- 5.0% vs 72.7% +/- 13.4%, p = 0.0501).
  
  
  CONCLUSIONS
  Stage discrepancy is common in surgically treated patients diagnosed with renal masses and it has a significant impact on clinical outcome. Implications of such clinical and pathological stage discrepancy should be considered when counseling patients and determining therapeutic approaches.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Michael P
authors.initials: MP
authors.lastname: Herman
authors.forename: Michael
authors.initials: M
authors.lastname: Hermann
authors.forename: David A
authors.initials: DA
authors.lastname: Duchene
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D010535:Laparoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome