Clinico-pathological analysis of renal cell carcinoma demonstrates decreasing tumour grade over a 17-year period.
BACKGROUND
Renal cell carcinoma (RCC) represents about 3% of adult malignancies in Ireland. Worldwide there is a reported increasing incidence and recent studies report a stage migration towards smaller tumours. We assess the clinico-pathological features and survival of patients with RCC in a surgically treated cohort.


METHODS
A retrospective analysis of all nephrectomies carried out between 1995 and 2012 was carried out in an Irish tertiary referral university hospital. Data recorded included patient demographics, size of tumour, tumour-node-metastasis (TNM) classification, operative details and final pathology. The data were divided into 3 equal consecutive time periods for comparison purposes: Group 1 (1995-2000), Group 2 (2001-2006) and Group 3 (2007-2012). Survival data were verified with the National Cancer Registry of Ireland.


RESULTS
In total, 507 patients underwent nephrectomies in the study period. The median tumour size was 5.8 cm (range: 1.2-20 cm) and there was no statistical reduction in size observed over time (p = 0.477). A total of 142 (28%) RCCs were classified as pT1a, 111 (21.9%) were pT1b, 67 (13.2%) were pT2, 103 (20.3%) were pT3a, 75 (14.8%) were pT3b and 9 (1.8%) were pT4. There was no statistical T-stage migration observed (p = 0.213). There was a significant grade reduction over time (p = 0.017). There was significant differences noted in overall survival between the T-stages (p < 0.001), nuclear grades (p < 0.001) and histological subtypes (p = 0.022).


CONCLUSIONS
There was a rising incidence in the number of nephrectomies over the study period. Despite previous reports, a stage migration was not evident; however, a grade reduction was apparent in this Irish surgical series. We can demonstrate that tumour stage, nuclear grade and histological subtype are significant prognosticators of relative survival in RCC.
Department of Urology, St Vincent's University Hospital, Dublin 4, Ireland.
Gregory J
GJ
Nason
Department of Urology, St Vincent's University Hospital, Dublin 4, Ireland.
Barry B
BB
McGuire
Department of Urology, St Vincent's University Hospital, Dublin 4, Ireland.
Michael E
ME
Kelly
Department of Urology, St Vincent's University Hospital, Dublin 4, Ireland.
Theodore M
TM
Murphy
Department of Urology, St Vincent's University Hospital, Dublin 4, Ireland.
Aisling T
AT
Looney
Department of Urology, St Vincent's University Hospital, Dublin 4, Ireland.
Damien P
DP
Byrne
Department of Urology, St Vincent's University Hospital, Dublin 4, Ireland.
David W
DW
Mulvin
Department of Urology, St Vincent's University Hospital, Dublin 4, Ireland.
David J
DJ
Galvin
Department of Urology, St Vincent's University Hospital, Dublin 4, Ireland.
David M
DM
Quinlan
Department of Urology, St Vincent's University Hospital, Dublin 4, Ireland.
Gerald M
GM
Lennon