Renal cell carcinoma: Prognostic factors and patient selection

Renal cell carcinoma (RCC) accounts for 2% of all new cancer cases worldwide. Staging systems for RCC are a valuable tool for guiding patient selection for the various treatment regimens and clinical trials. Integration of pathologic tumour stage with histologic and clinical features has led to the development of a number of comprehensive prognostication systems to predict patient outcomes. More recent work has highlighted the additional prognostic value of a range of molecular markers, which may correlate disease status with likely response to treatment. For example, results from a number of studies have indicated that the expression of carbonic anhydrase IX and the vascular endothelial growth factor family of proteins and receptors may be important for predicting the survival rate of patients with distant metastases. Incorporation of molecular markers into staging systems is expected to enhance the prediction of individual tumour behaviours and help to stratify patients into more sophisticated risk categories to improve accurate prognostication. Furthermore, use of molecular markers to direct targeted therapies to the patients who would gain most benefit may ultimately enable improved treatment success and, thus, maximise survival benefits. (c) 2007 Published by Elsevier B.V. on behalf of European Association of Urology.