title: Urinary collecting system invasion is an independent prognostic factor of organ confined renal cell carcinoma.
abstract: OBJECTIVE
  We evaluated urinary collecting system invasion as a prognostic parameter of renal cell carcinoma.
  
  
  METHODS
  A total of 1,124 patients who underwent nephrectomy for a renal tumor at 5 European centers were included in this retrospective study. Several variables were analyzed including urinary collecting system invasion, age, sex, TNM stage, Fuhrman grade, histological subtype, Eastern Cooperative Oncology Group performance status and cancer specific survival.
  
  
  RESULTS
  There were 771 males (68.6%) and 353 females (31.4%) in this study, and median age was 61 years (range 14 to 88). Median tumor size was 6 cm (range 1 to 24). Tumors were organ confined and Fuhrman grade was recorded as 1 or 2 in 67.1% and 62.3% of cases, respectively. Symptoms were present at diagnosis, and Eastern Cooperative Oncology Group performance status was 1 or more in 50.3% and 16.1% of the cases, respectively. Median followup was 43 months (range 1 to 299). At the end of followup 246 patients (21.9%) died of cancer. In 132 cases (11.7%) urinary collecting system invasion was noted. Urinary collecting system invasion was associated with symptoms, TNM stage, Fuhrman grade, tumor size (p <0.001) and Eastern Cooperative Oncology Group performance status (p = 0.003), but not with histological subtype (p = 0.7). On univariate analysis TNM stage, Fuhrman grade, symptoms, Eastern Cooperative Oncology Group performance status, tumor size and urinary collecting system invasion (p = 0.0001) were significant predictors of cancer specific survival. Urinary collecting system invasion was an independent prognostic parameter only in the setting of pT1-T2 tumors. When the urinary collecting system was invaded the 5 and 10-year probabilities of survival were 43% and 41%, respectively.
  
  
  CONCLUSIONS
  Urinary collecting system invasion appears to be an independent prognostic parameter of organ confined renal cell carcinoma. Our data support the need to integrate this parameter in further TNM revisions.
authors.affiliation: Rennes University Hospital, Rennes, France. gregory.verhoest@wanadoo.fr
authors.forename: Grégory
authors.initials: G
authors.lastname: Verhoest
authors.forename: Raffi
authors.initials: R
authors.lastname: Avakian
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thuret
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
authors.forename: Jacques
authors.initials: J
authors.lastname: Tostain
authors.forename: François
authors.initials: F
authors.lastname: Guille
authors.forename: Lucas
authors.initials: L
authors.lastname: Cindolo
authors.forename: Alexandre
authors.initials: A
authors.lastname: De La Taille
authors.forename: Claude-Clément
authors.initials: CC
authors.lastname: Abbou
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D007685:Kidney Tubules, Collecting / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult