World Journal of Urology

, Volume 23, Issue 1, pp 50–54 | Cite as

Impact of tumor size on the long-term survival of patients with early stage renal cell cancer

  • M. KuczykEmail author
  • G. Wegener
  • A. S. Merseburger
  • A. Anastasiadis
  • S. Machtens
  • A. Zumbrägel
  • J. T. Hartmann
  • C. Bokemeyer
  • Udo Jonas
  • A. Stenzl
Free Paper


As the biological behaviour of even early stage renal cell cancer (RCC) strongly correlates with tumor size, it has been argued that the inclusion of RCC up to a maximum diameter of 7 cm into a common subgroup classified as T1 according to the 5th edition of the TNM system would not adequately represent the different biological aggressiveness of these malignancies. Taking this into account, the TNM classification, which now categorizes T1 RCC as T1a and T1b according to a cutoff size of 4 cm, was recently modified. However, only a few larger investigations, mainly based on univariate statistical analyses, that support the suitability of this cutoff are at present available from the literature. Therefore, it was the aim of the present investigation to determine the tumor size that best separates patients with low responses from those with high risk for tumor progression by univariate (log rank test) and multivariate (Cox regression model) statistical analyses. Between 1981 and 2000, 652 patients (443 males and 209 females) underwent tumor nephrectomy in our clinic for the diagnosis of RCC. Of these, 243 patients revealed primary tumors with a local growth not extending beyond the renal capsula at the time of surgery. For the different cutoff levels (starting from 2 cm in increments of 1 cm up to 8 cm) that were selected to subdivide the patients into groups according to the maximum tumor diameter, the correlation between tumor size and overall survival was determined by univariate and multivariate statistical analyses. It became evident that although during univariate analysis the prognostic value of a cutoff size of 4 cm was confirmed, multivariate analysis identified the highest relative risk for cause-specific death (2.93) for patients having tumors larger than 5 cm in maximum diameter. Therefore, the 5 cm cutoff seems to best determine the clinical prognosis of patients undergoing tumor nephrectomy for early stage RCC. The present study demonstrates the need for multivariate statistical approaches when the latest modification of the TNM classification system is critically evaluated.


Renal cell cancer Clinical prognosis Tumor size Mulitvariate analysis Univariate analysis 


  1. 1.
    Sobin LH, Wittekind CH (1997) TNM classification of malignant tumours, 5th edn. Wiley-Liss, New YorkGoogle Scholar
  2. 2.
    Wittekind C, Meyer H.-J., Bootz F (2002) TNM-Klassifikation maligner Tumoren, 6th edn. Springer, Berlin HeidelbergGoogle Scholar
  3. 3.
    Javidan J, Stricker HJ, Tamboli P, Amin MB, Peabody JO, Deshpande A, Menon M, Amin MB (1999) Prognostic significance of the 1997 TNM classification of renal carcinoma. J Urol 162: 1277CrossRefGoogle Scholar
  4. 4.
    Minervini R, Minervini A, Fontana N, Traversi C, Cristofani R (2000) Evaluation of the 1997 tumour, nodes and metastases classification of renal cell carcinoma: experience in 172 patients. Br Urol 86: 19Google Scholar
  5. 5.
    Guinan P, Sobin LH, Algaba F, Badellino F, Kameyama S, MacLennan G, Novick A (1997) TNM staging of renal cell carcinoma. Workgroup no 3. Cancer 80: 992CrossRefGoogle Scholar
  6. 6.
    Hafez KS, Fergany AF, Novick AC (1999) Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol 162: 1930Google Scholar
  7. 7.
    Licht M, Novick AC, Goormastic M (1994) Nephron sparing surgery in incidental vs suspected renal cell carcinoma. J Urol 152: 39Google Scholar
  8. 8.
    Lerner SE, Hawkins CA, Blute ML, Grabner A, Wollan PC, Eickholt JT, Zincke H (1996) Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol 155: 1868CrossRefPubMedGoogle Scholar
  9. 9.
    Shinohara N, Harabayashi J, Koyanagi T (2001) Stage-specific follow-up protocol after radical nephrectomy for renal cell carcinoma: could we follow the T1B patients by a same follow-up protocol of T1A patients? J Urol 165 [Suppl]: 161Google Scholar
  10. 10.
    Gettman MT, Blute ML, Spotts B, Bryant SC, Zincke H (2001) Pathologic staging of renal cell carcinoma. Significance of tumor classification with the 1997 staging system. Cancer 91: 354CrossRefGoogle Scholar
  11. 11.
    Krejci KG, Frank I, Blute ML. Grade-and size-specific outcomes for stage T1 renal cell carcinoma (RCC) after nephron sparing surgery (NSS). J Urol [Suppl]: 158Google Scholar
  12. 12.
    Zisman A, Pantuck AJ, Chao D, Dorey F, Said JW, Gitlitz BJ, De Kernion JB, Figlin RA, Belldegrun AS (2001) Reevaluation of the 1997 TNM classification for renal cell carcinoma: T1 and T2 cutoff point at 4.5 cm rather than 7 cm better correlates with clinical outcome. J Urol 166: 54CrossRefGoogle Scholar
  13. 13.
    Slaton JW, Levy DA, Perrotte P et al. (2001) Practical application of renal cell carcinoma prognostic factors to a risk factor driven approach to tumor surveillance after radical nephrectomy. J Urol 165 [Suppl]: 160Google Scholar
  14. 14.
    Delahunt B, Kittelson JM, McCredie MR, Reeve AE, Stewart JH, Bilous AM (2002) Prognostic importance of tumor size for localized conventional (clear cell) renal cell carcinoma. Cancer : 658Google Scholar
  15. 15.
    Walker JR, Choyke PL, Glenn G et al. (2001) Association of renal tumor size and metastasis in four different hereditary renal tumor syndromes. J Urol [Suppl]: 160Google Scholar
  16. 16.
    Delahunt B, Eble JN (1997) Papillary adenoma of the kidney: an evolving concept. J Pathol 7: 99Google Scholar
  17. 17.
    Baltaci S, Orhan D, Soyupek S et al. (2000) Influence of tumor stage, size, grade, vascular involvement, histological cell type and histological pattern on multifocality of renal cell carcinoma. J Urol 164: 36CrossRefPubMedGoogle Scholar
  18. 18.
    Turner KJ, Huson SM, Moore N, Britton BJ, Cranston D (2001) Von Hippel-Lindau disease: renal tumors less than 3 cm can metastasize. J Urol 165: 1207CrossRefGoogle Scholar
  19. 19.
    Elmore JM, Kadesky KT, Koeneman KS, Sagalowsky AL(2002) Reassessing the 1997 TNM classification system for renal cell carcinoma: a 5.0 cm T1/T2 cut-off better stratifies clinical outcome. J Urol 167 [Suppl]: 194Google Scholar
  20. 20.
    Miller J, Fischer C, Freese R, Altmannsberger M, Weidner W (1999) Nephron-sparing surgery for renal cell carcinoma: is tumor size a suitable parameter for indication. Urology 54: 988CrossRefGoogle Scholar
  21. 21.
    Kuczyk M, Münch T, Machtens S, Bokemeyer C, Wefer A, Hartmann J, Kollmannsberger C, Kondo M, Jonas U (2002) The need for routine adrenalectomy during surgical treatment for renal cell cancer: the Hanover experience. BJU Int 89: 517CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • M. Kuczyk
    • 1
    Email author
  • G. Wegener
    • 2
  • A. S. Merseburger
    • 1
  • A. Anastasiadis
    • 1
  • S. Machtens
    • 4
  • A. Zumbrägel
    • 1
  • J. T. Hartmann
    • 3
  • C. Bokemeyer
    • 3
  • Udo Jonas
    • 4
  • A. Stenzl
    • 1
  1. 1.Department of UrologyEberhard Karls University
  2. 2.Clinical Cancer RegistryHannover University Medical School
  3. 3.Department of Hematology/OncologyEberhard Karls University
  4. 4.Department of UrologyHannover University Medical School

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