Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: Are further improvements needed?

Giacomo Novara, Vincenzo Ficarra, Alessandro Antonelli, Walter Artibani, Roberto Bertini, Marco Carini, Sergio Cosciani Cunico, Ciro Imbimbo, Nicola Longo, Guido Martignoni, Giuseppe Martorana, Andrea Minervini, Vincenzo Mirone, Francesco Montorsi, Roberto Schiavina, Claudio Simeone, Sergio Serni, Alchiede Simonato, Salvatore Siracusano, Alessandro VolpeGiorgio Carmignani, O. De Cobelli, S. Corti, M. Castelli, S. Cimino, V. Favilla, G. Morgia, M. Billia, C. Terrone, L. Masieri, F. Oneto, V. Varca, F. Rocco, E. Costantini, M. Porena, A. Zucchi, S. Ciciliato, N. Lampropoulou, D. Fontana, P. Gontero, A. Tizzani, M. Brunelli, G. Martignoni, C. Valotto, F. Zattoni, G. Petralia, M. Roscigno, E. Strada

Research output: Contribution to journalArticlepeer-review


Background: A new edition of the TNM was recently released that includes modifications for the staging system of kidney cancers. Specifically, T2 cancers were subclassified into T2a and T2b (≤10 cm vs >10 cm), tumors with renal vein involvement or perinephric fat involvement were classified as T3a cancers, and those with adrenal involvement were classified as T4 cancers. Objective: Our aim was to validate the recently released edition of the TNM staging system for primary tumor classification in kidney cancer. Design, setting, and participants: Our multicenter retrospective study consisted of 5339 patients treated in 16 academic Italian centers. Intervention: Patients underwent either radical or partial nephrectomy. Measurements: Univariable and multivariable Cox regression models addressed cancer-specific survival (CSS) after surgery. Results and limitations: In the study, 1897 patients (35.5%) were classified as pT1a, 1453 (27%) as pT1b, 437 (8%) as pT2a, 153 (3%) as pT2b, 1059 (20%) as pT3a, 117 (2%) as pT3b, 26 (0.5%) as pT3c, and 197 (4%) as pT4. At a median follow-up of 42 mo, 786 (15%) had died of disease. In univariable analysis, patients with pT2b and pT3a tumors had similar CSS, as did patients with pT3c and pT4 tumors. Moreover, both pT3a and pT3b stages included patients with heterogeneous outcomes. In multivariable analysis, the novel classification of the primary tumor was a powerful independent predictor of CSS (p for trend

Original languageEnglish
Pages (from-to)588-595
Number of pages8
JournalEuropean Urology
Issue number4
Publication statusPublished - Oct 2010


  • Kidney neoplasm
  • Nephrectomy
  • Renal cell carcinoma
  • TNM

ASJC Scopus subject areas

  • Urology


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