Prognostic factors and staging systems for renal cell carcinoma

Objectives: Primary tumour local extension, lymph-node status, and the presence of metastases have always been considered the most important prognostic factors in renal cell carcinoma (RCC). In recent years, many other clinical, pathological, and molecular factors able to independently predict survival in RCC have been proposed and discussed. The aim of this unsystematic literature review is to describe the most important advances in RCC prognostication. Results: The review provides updated. information regarding the most important clinical. (performance status, localized or systemic symptoms), pathological (Fuhrman nuclear grade, histological subtypes, sarcomatoid features, tumour necrosis), and molecular (molecules involved in the hypoxia-inducible pathway, proliferation, cell cycle regulation, or cell adhesion) prognostic factors. It also highlights the issues related to RCC staging systems, such as the debate about the ideal cut-off to stratify patients with localized disease into two categories with different survival as well as the different prognostic impact of perinephric fat invasion, ipsilateral adrenal gland involvement, venous axis neoplastic thrombosis, and the possible synergjstic role of their association in locally advanced disease. Conclusions: The ongoing development of integrated models combining different features improves the accuracy of survival prediction, thus allowing more detailed patient information, correct follow-up planning, and adequate recruitment and interpretation of clinical trials. (c) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.