Kidney
199
Rules for Classification The classification applies only to renal cell carcinoma. There should be histological confirmation of the disease. The following are the procedures for assessing T, N, and M categories: T categories Physical examination and imaging N categories Physical examination and imaging M categories Physical examination and imaging
Regional Lymph Nodes The regional lymph nodes are the hilar, abdominal para‐aortic, and paracaval nodes. Laterality does not affect the N categories.
TNM Clinical Classification T – Primary Tumour TX T0
Primary tumour cannot be assessed No evidence of primary tumour
T1 Tumour 7 cm or less in greatest dimension, limited to the kidney T1a Tumour 4 cm or less T1b Tumour more than 4 cm but not more than 7 cm T2 Tumour more than 7 cm in greatest dimension, limited to the kidney T2a Tumour more than 7 cm but not more than 10 cm T2b Tumour more than 10 cm, limited to the kidney T3 Tumour extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota fascia T3a Tumour grossly extends into the renal vein or its segmental (muscle containing) branches, or tumour invades perirenal and/ or renal sinus fat (peripelvic) fat but not beyond Gerota fascia T3b Tumour grossly extends into vena cava below diaphragm T3c Tumour grossly extends into vena cava above the diaphragm or invades the wall of the vena cava T4 Tumour invades beyond Gerota fascia (including contiguous e xtension into the ipsilateral adrenal gland)
Urological
Kidney (ICD‐O‐3 C64)
200
Urological Tumours
N – Regional Lymph Nodes NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis in regional lymph node(s)
M – Distant Metastasis M0 No distant metastasis M1 Distant metastasis
pTNM Pathological Classification The pT and pN categories correspond to the T and N categories. For pM see page 8.
Stage Stage I Stage II Stage III Stage IV
T1 T2 T3 T1, T2, T3 T4 Any T
N0 N0 N0 N1 Any N Any N
M0 M0 M0 M0 M0 M1
Kidney
201
Prognostic Factors Grid – Kidney
Prognostic factors
Tumour related
Host related
Essential
Stage
Surgical candidacy
Additional
Histological subtype Fuhrman grade (clear cell RCC only) Histological features of necrosis, sarcomatoid histology Symptom score
Performance status Hereditary diseases
Investigational
DNA ploidy Genetic alterations Molecular markers
Environment related
Lymph node dissection Adrenalectomy Metastatectomy Immunotherapy/ targeted therapy
Source: UICC Manual of Clinical Oncology, Ninth Edition. Edited by Brian O’Sullivan, James D. Brierley, Anil K. D’Cruz, Martin F. Fey, Raphael Pollock, Jan B. Vermorken and Shao Hui Huang. © 2015 UICC. Published 2015 by John Wiley & Sons, Ltd.
Urological
Prognostic factors for cancers of the kidney