title: [Validation of 2009 TNM classification based on a prognostic analysis of 350 patients treated for renal cell carcinoma].
abstract: OBJECTIVE
  To validate 2009 TNM classification (7th edition) of renal cell carcinoma (RCC), we reevaluated our RCC database depends on 6th and 7th TNM staging and analyzed a prognostic divergence between subgroups.
  
  
  METHODS
  A study population of 350 patients with RCC was retrospectively reviewed based on the TNM classification both 6th and 7th editions. Cause-specific survival (CSS) in each group was estimated using Kaplan-Meier method.
  
  
  RESULTS
  Applying the new TNM system, 336 patients were divided into pT1a 131, pT1b 105, pT2a 31, pT2b 13, pT3 a 38, pT3b 3, pT3c 0, pT4 14. Previously pT3b-staged 11 cases with renal vein involvement without vena caval extension were included into pT3a. Due to the positive direct invasion into the adrenal gland, previously pT3-staged six patients were changed to pT4. Kaplan-Meier curves revealed no significant differences in CSS between each a/b subgroups from pT1 to pT3. Particularly, no significant statistical value was recognized between pT2a and pT2b subgroups. Patients with direct adrenal invasion tended to show a less favorable prognosis than those with invasion beyond Gerota.
  
  
  CONCLUSIONS
  (1) pT2 subdivision does not affect prognostic value. (2) Population imbalance is enhanced due to the pT 3 reclassification. (3) Direct adrenal invasion is compatible with pT4 category.
authors.affiliation: Department of Urology, National Hospital Organization Osaka National Hospital.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasunaga
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Komori
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Harada
authors.forename: Akira
authors.initials: A
authors.lastname: Tohda
authors.forename: Toshitsugu
authors.initials: T
authors.lastname: Oka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000592:standards*; D012189:Retrospective Studies