Staging of renal cell carcinoma: 2010 TNM classification system and validation in Turkey

Aim: AJCC (American Joint Committee on Cancer) / UICC (Union for International Cancer Control) TNM primary tumor classification system was updated to 7th edition in January 2010. In the new edition, pT2 stage was subdivided in to pT2a (tumor size 7-10 cm) and pT2b (tumor size > 10 cm) stages. Renal vein invasion was reclassified as pT3a, and ipsilateral adrenal involvement was reclassified as pT4. Single or multiple lymph node involvement was reclassified as pN1. In this study, we were reviewed changes made in 2010 TNM system. New findings: Changes made in pT2 were evaluated in multiple studies. However, no cut-off value could be determined on tumor size. Each of tumor thrombus level, perinephric invasion and renal sinus fat invasion are important prognostic parameters in staging advanced (pT3 and pT4) renal cell carcinoma. Further updates are needed in new TNM editions by seperating tumor thrombus level and perinephric invasion from the same stage (pT3a). Conclusion: Increasing number of anatomical extent locations (perinephric invasion, adrenal, renal vein involvement etc.) worsen prognosis of the disease. As shown in a number of papers cancer specific survival but not prognostic accuracy improved with changes made in 2010 TNM edition.