title: Renal cell carcinoma stage migration in a single European centre over 25 years: effects on 5- and 10-year metastasis-free survival.
abstract: OBJECTIVE
  To assess renal cell carcinoma (RCC) stage migration in a large European academic centre series over 25 years and its possible impact on patients' metastasis-free survival.
  
  
  METHODS
  The pathology reports of 2,333 consecutive patients with RCC who underwent nephrectomy from 1984 to 2006 at our institution were systematically re-evaluated. Patients were pooled into four groups according to the date of surgery: group 1: 1984-1989, group 2: 1990-1995, group 3: 1996-2001 and group 4: 2002-2006, respectively. Changes in pT-categories over time and the impact on 5- and 10-year metastasis-free survival were evaluated.
  
  
  RESULTS
  Organ-confined (pT1 and pT2) tumours were found in 191/502 (38.0 %) and 372/535 (69.5 %) surgical specimens in groups 1 and 4, respectively (p < 0.001). This stage migration was mainly the result of an increase in pT1a tumours (overall: 32.6 %) from 12.5 % in group 1 to 45.8 % in group 4 and a decrease in pT3a tumours (overall: 24.1 %) from 46.6 % in group 1 to 11.0 % in group 4 (p < 0.001). The mean tumour size decreased from 6.7 cm in group 1 to 4.8 cm in group 4 (p < 0.001). In 2,152 patients with non-metastatic RCC, median follow-up was 76.2 (interquartile range: 36.2-133.9) months. Five- and 10-year metastasis-free survival probabilities were 78.7 and 71.9 % in group 1, 85.3 and 80.0 % in group 2, and 86.9 and 82.7 % in group 3, respectively. Five-year metastasis-free survival in group 4 was 90.3 % (p < 0.001).
  
  
  CONCLUSIONS
  A statistically significant stage migration towards organ-confined RCC was observed in the cohort studied. This stage migration was accompanied by a significant improvement in metastasis-free survival comparing the period 1984-1989 and following time periods.
authors.affiliation: Division of Oncology, Department of Internal Medicine, Medical University of Graz (MUG), Auenbruggerplatz 25, 8036 Graz, Austria. mart.pichler@gmx.net
authors.forename: Martin
authors.initials: M
authors.lastname: Pichler
authors.forename: Georg C
authors.initials: GC
authors.lastname: Hutterer
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Chromecki
authors.forename: Johanna
authors.initials: J
authors.lastname: Jesche
authors.forename: Karin
authors.initials: K
authors.lastname: Kampel-Kettner
authors.forename: Karl
authors.initials: K
authors.lastname: Pummer
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
mesh_terms: D001317:Austria / Q000453:epidemiology; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000453:epidemiology / Q000556:secondary*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors