title: A review of integrated staging systems for renal cell carcinoma.
abstract: BACKGROUND
  Several outstanding integrated staging systems (ISSs) have been devised for patients with renal cell carcinoma (RCC).
  
  
  OBJECTIVE
  To review the available literature on existing ISSs.
  
  
  METHODS
  A nonsystematic search was conducted using Medline and PubMed databases. Original articles, review articles, and editorials addressing the development and validation of ISSs in RCC published up to February 2012 were identified. The search was limited to the English language. Keywords included kidney cancer, renal cell carcinoma, nomogram, risk group, prognosis, predictive accuracy, external validation, and discrimination. Links to related articles and cross-reading of citations in related articles were surveyed. All articles with a pertinent level of evidence were included and represent the basis for the current review article.
  
  
  RESULTS
  In nephrectomy patients, a variety of models have been developed for prediction of recurrence and survival, both in the preoperative and postoperative settings. Several of those models relied on variables that are not routinely available in clinical practice. Not all tools were externally validated. In patients treated with systemic therapy, novel tools that were developed and validated in the targeted therapy era replaced tools devised during the cytokine era.
  
  
  CONCLUSIONS
  The development of ISSs for prediction of risk or prognosis in the context of RCC has evolved and improved. In the targeted therapy era, the urologic community should focus on direct comparisons of existing tools with the intent of identifying the optimal ISS for each specific end point.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: Malek
authors.initials: M
authors.lastname: Meskawi
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Jens
authors.initials: J
authors.lastname: Hansen
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.forename: Salima
authors.initials: S
authors.lastname: Ismail
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: 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; D008954:Models, Biological; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D049451:Nomograms; D011379:Prognosis; D016896:Treatment Outcome