title: Prognostic and discriminative power of the 7th TNM classification for patients with surgically treated papillary renal cell carcinoma: results of a multi-institutional validation study (CORONA subtype project).
abstract: OBJECTIVE
  Studies on the prognostic reliability of the Union for International Cancer Control tumor, node, metastasis (TNM) staging system for renal cell carcinoma (RCC) predominantly focus on clear-cell RCC. Therefore, the aim of this study was to investigate whether the oncological prognosis of surgically treated papillary RCC (papRCC) patients is reliably given by the current TNM system, by analyzing the largest database reported to date.
  
  
  METHODS
  Data on 2325 papRCC patients who underwent surgical treatment in 1984- 2015 were collated from 17 international centers (median follow-up 47 months). Tumor stage was adapted to the 7th edition of the TNM system. Multivariable, bootstrap-corrected Cox regression models were applied to assess the independent impact of the TNM system on cancer-specific mortality (CSM) and all-cause mortality (ACM).
  
  
  RESULTS
  The median age at diagnosis was 63 years (interquartile range 54-70 years) and 77% of patients were male. Nephron-sparing surgery was performed in 42%, and 82% were with symptom free at diagnosis. In 6.7% (n = 156), organ metastasis (stage M1) was present at the time of surgery. On multivariable analysis, the TNM system and Fuhrman grade had an independent impact on both CSM and ACM, while patient age affected ACM only. The discriminative ability of the pT classification was significant for both endpoints: 5 year CSM rates were 5%, 17%, 36% and 56% for stages pT1, pT2, pT3 and pT4, respectively (each p < 0.001). The pT classification contributed significantly to the predictive accuracy of the CSM and ACM models by 6.3% and 2.5%, respectively (each p < 0.001).
  
  
  CONCLUSIONS
  The 2010 TNM staging system can be reliably applied to papRCC patients and allows certain prognostic discrimination.
authors.affiliation: a Department of Urology , Klinikum St. Elisabeth Straubing , Straubing , Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.affiliation: b Centre of Urological Surgery, Dialysis and Renal Transplantation , Fundeni Clinical Institute , Bucharest , Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Surcel
authors.affiliation: c Department of Urology , Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute , Milan , Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.affiliation: c Department of Urology , Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute , Milan , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: d Department of Urology , Medical University of Vienna , Vienna , Austria.
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
authors.affiliation: d Department of Urology , Medical University of Vienna , Vienna , Austria.
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Shariat
authors.affiliation: e Department of Urology , Hospital Bad Saarow , Bad Saarow , Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Ecke
authors.affiliation: f Department of Urology , Carl-Thiem-Klinikum Cottbus , Cottbus , Germany.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Wolff
authors.affiliation: g Department of Urology and Paediatric Urology , Julius-Maximilians-University Medical Centre of Wuerzburg , Wuerzburg , Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vergho
authors.affiliation: h Department of Urology , University Hospital Mannheim , Mannheim , Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Wagener
authors.affiliation: h Department of Urology , University Hospital Mannheim , Mannheim , Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Huck
authors.affiliation: i Department of Urology , Klinikum Nürnberg , Nürnberg, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Pahernik
authors.affiliation: j Department of Urology , Carl Gustav Carus University Dresden, University Hospital , Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zastrow
authors.affiliation: j Department of Urology , Carl Gustav Carus University Dresden, University Hospital , Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Wirth
authors.affiliation: k Department of Urology , University Hospital Mainz , Mainz , Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Borgmann
authors.affiliation: k Department of Urology , University Hospital Mainz , Mainz , Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haferkamp
authors.affiliation: l Department of Nephrology and Urology , University of Barcelona , Barcelona , Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Musquera
authors.affiliation: m Department of Urology , University of Muenster Medical Center , Muenster , Germany.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Krabbe
authors.affiliation: m Department of Urology , University of Muenster Medical Center , Muenster , Germany.
authors.forename: Edwin
authors.initials: E
authors.lastname: Herrmann
authors.affiliation: n Department of Urology , Instituto Nacional de Cancerologia-INCan , Mexico City , Mexico.
authors.forename: Anna
authors.initials: A
authors.lastname: Scavuzzo
authors.affiliation: b Centre of Urological Surgery, Dialysis and Renal Transplantation , Fundeni Clinical Institute , Bucharest , Romania.
authors.forename: Cristian
authors.initials: C
authors.lastname: Mirvald
authors.affiliation: o Department of Urology , Medical University Graz , Graz , Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Hutterer
authors.affiliation: o Department of Urology , Medical University Graz , Graz , Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.affiliation: p Department of Urology , Ludwig-Maximilians University, Campus Grosshadern , Munich , Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.affiliation: p Department of Urology , Ludwig-Maximilians University, Campus Grosshadern , Munich , Germany.
authors.forename: Raphaela
authors.initials: R
authors.lastname: Waidelich
authors.affiliation: q Department of Urology , Pio Da Pietrelcina Hospital , Vasto , Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.affiliation: r Department of Urology , Faculty of Medicine, Charles University , Pilsen , Czech Republic.
authors.forename: Krystina
authors.initials: K
authors.lastname: Kalusova
authors.affiliation: p Department of Urology , Ludwig-Maximilians University, Campus Grosshadern , Munich , Germany.
authors.forename: Sabine D
authors.initials: SD
authors.lastname: Brookman-May
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; 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; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D055815:Young Adult
keywords: Papillary renal cell carcinoma; UICC TNM system 2010; predictive accuracy; prognostic discrimination; surgical treatment