title: Prognostic impact of tumor size on pT2 renal cell carcinoma: an international multicenter experience.
abstract: OBJECTIVE
  The current tumor classification for renal cell carcinoma classifies pT2 tumors as larger than 7 cm in greatest dimension and limited to the kidney. We examined the current pT2 tumor classification of renal cell carcinoma and determined whether a tumor size cutoff exists that would improve prognostic accuracy.
  
  
  METHODS
  We studied 706 patients with pT2 renal cell carcinoma treated with surgical extirpation at 9 international academic centers. Data collected from each patient included age at diagnosis, gender, 2002 TNM (tumor, node, metastasis) stage, tumor size, nuclear grade, performance status, histological subtype and disease specific survival. Disease specific survival was evaluated with univariate and multivariate analysis.
  
  
  RESULTS
  Median followup was 52 months. Univariate Cox regression analysis showed a significant association of tumor size with disease specific survival (HR 1.11, p<0.001). An ideal tumor size cutoff of 11 cm was identified, which led to the stratification of 2 groups with respect to disease specific survival (p<0.0001) with 5 and 10-year survival rates of 73% and 65% for pT2 11 cm or less, and 57% and 49% for pT2 larger than 11 cm, respectively. The incidence of metastases was significantly greater in the larger than 11 cm group, while Eastern Cooperative Oncology Group performance status, Fuhrman grade and histological subtype were similar. Multivariate Cox regression analysis retained tumor size as an independent prognostic factor and as the strongest prognostic factor for patients with pT2N0M0 disease.
  
  
  CONCLUSIONS
  Our data suggest that the current pT2 classification can be improved by subclassification into pT2a and pT2b based on a tumor size cutoff of 11 cm. Patients in the proposed pT2bN0M0 group are at higher risk for death from renal cell carcinoma and should be considered for adjuvant therapies. External validation is warranted before suggesting change to the TNM classification.
authors.affiliation: Department of Urology, University of California, Los Angeles, Los Angeles, California 90095-1738, USA, and Centre Hospitalier Universitaire Pontchaillou, Rennes, France.
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Rakhee H
authors.initials: RH
authors.lastname: Goel
authors.forename: Mark D
authors.initials: MD
authors.lastname: Kleid
authors.forename: Francois
authors.initials: F
authors.lastname: Guille
authors.forename: Bernard
authors.initials: B
authors.lastname: Lobel
authors.forename: Clement-Claude
authors.initials: CC
authors.lastname: Abbou
authors.forename: Alexandre
authors.initials: A
authors.lastname: De La Taille
authors.forename: Jacques
authors.initials: J
authors.lastname: Tostain
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Altieri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
authors.forename: Tommaso
authors.initials: T
authors.lastname: Prayer-Galetti
authors.forename: Ernst Peter
authors.initials: EP
authors.lastname: Allhoff
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Robert A
authors.initials: RA
authors.lastname: Figlin
authors.forename: Fairooz F
authors.initials: FF
authors.lastname: Kabbinavar
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pantuck
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
authors.forename: John S
authors.initials: JS
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000145:classification*; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis