Urinary collecting system invasion is no independent prognostic factor in renal cell carcinoma.
OBJECTIVE
To assess the specific impact of urinary collecting system (UCS) invasion on the long-term prognosis of patients with renal cell carcinoma (RCC).


METHODS
We evaluated 1,678 patients with complete information about UCS invasion of their primary RCC who had undergone renal surgery between 1990 and 2005 in two high volume centers (MH Hannover and Marburg, Germany); the mean follow-up was 5.4 years.


RESULTS
Hundred and forty-nine (8.9%) patients demonstrated collecting system invasion. These patients incurred a significant increase in the likelihood of cancer-related death (HR 1.7, 95% CI: 1.4-2.0; P < 0.001), their median 5-year tumor-specific survival rate was 45% as opposed to 73% for patients without UCS invasion (P < 0.001). UCS invasion was significantly associated with tumor stage, grade, lymph node, and visceral metastasis at diagnosis but not with age, gender, histologic subtype, or body mass index. However, using multivariate analysis, UCS invasion disqualified as individual prognostic factor for RCC, neither for localized nor for advanced disease.


CONCLUSIONS
Facing the results of this large trial, we do not support the inclusion of UCS invasion into upcoming TNM staging systems. In contrast, future research should focus on novel molecular markers expressed by the tumor and/or specific immunological characteristics of patients with RCC which could improve prediction of RCC-associated prognosis.
Department of Urology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Sandra
S
Waalkes
Axel S
AS
Merseburger
Thomas R W
TR
Herrmann
Mario W
MW
Kramer
Gerd
G
Wegener
Julia
J
Rustemeier
Rainer
R
Hofmann
Markus A
MA
Kuczyk
Andres J
AJ
Schrader
D001707:Biopsy, Needle; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D007685:Kidney Tubules, Collecting / Q000473:pathology*; D008297:Male; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors