Traditional prognostic factors of renal cell carcinoma: A critical reappraisal

G. Carmignani, F. Oneto, C. Giberti

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Renal cell carcinoma is a tumor with a reportedly unpredictable natural history, a reportedly unfavourable prognosis and relatively low definitive cure rate. Surgery is still the only effective therapy and up to now no adjuvant therapy has proven to be useful. The knowledge of prognostic factors of renal cell carcinoma is fundamental in order to optimize the aggressiveness of surgery and its cost vs benefit ratio in the individual patient. In this paper the authors extensively review the literature on this issue as well as their own experience. The following parameters appear to be the most important in determining patient prognosis: synchronous metastases, tumor grade, tumor stage; nodal invasion and vena caval tumour thrombus appear to be of lesser importance. Regarding nodal invasion this may be due to the fact that in the authors' experience extended lymphadenectomy minimizes the impact of microscopic nodal metastases; for venacaval involvement it seems that its adverse impact on prognosis is due to its relationship with other unfavourable prognostic factors. As a conclusion the authors state that renal cell carcinoma patients may be subdivided in three categories: a) good prognosis: patients with pT1 to pT3 tumours but pN0M0V0. b) intermediate prognosis: patients with nodal metastases alone or with venous involvement alone. In these patients, although they are a small portion of the total, radical extensive surgery with extended lymphadenectomy and/or aggressive management of venacaval tumour thrombus is warranted. c) poor prognosis: patients with pT4 tumours, patients with nodal and venous involvement, patients with distant metastases, patients with G3 tumours; in these patients radical extensive surgery cannot add anything in terms of survival, and probably, quality of life. Therefore in such patients surgery must be viewed in terms of palliation.

Original languageEnglish
Pages (from-to)103-110
Number of pages8
JournalActa Urologica Italica
Issue number2
Publication statusPublished - 1997


  • extended lymphadenectomy
  • prognostic factors
  • radical surgery
  • renal cell carcinoma
  • vena caval tumour thrombus

ASJC Scopus subject areas

  • Urology


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