Prognostic factors in renal cancer

Abstract

A wide variety of histologic prognostic parameters have been proposed for renal cell carcinoma and of these tumor morphotype, tumor grade, sarcomatoid and rhabdoid differentiation, and tumor necrosis were accepted as having utility in clinical practice by the Consensus Conference on Renal Neoplasia assembled by the International Society of Urological Pathology in Vancouver in 2012. With respect to morphotype it was determined that both papillary and chromophobe RCC have a more favourable prognosis than clear cell RCC, while collecting duct RCC was recognised as having a poor prognosis. At the conference it was agreed that for clear cell and papillary RCC grading should based on nucleolar prominence alone for grade 1 to 3 tumours, and that grade 4 tumors should be defined by the presence of extreme nuclear pleomorphism, tumor giant cells and/or rhabdoid/sarcomatoid differentiation. It was further agreed that chromophobe RCC should not be graded. For necrosis there was consensus that the presence or absence of tumour necrosis should be routinely included in the histological report and that this should be based upon both macroscopic and histological examination. There was also consensus that the area of necrosis should be recorded as a percentage of the total tumour area.