The Role of Pathology for Clinical Decision-Making in Renal Cell Carcinoma is Increasing

Abstract

0302-2838/$ – see back matter # 2007 European Association of Urology. Pub what the pathology report of adult kidney tumours should provide to assist the urologist in clinical decision-making [1]. The Uropathology Working Group of the European Society of Pathology, the European Working Group of Uropathology of the European Association of Urology (EAU) and several EAU urologists were involved. The article focuses on the assessment of radical nephrectomy specimens. The TNM staging system should always be used by the pathologist to classify local extension of the primary tumour, lymph node involvement, and presence of distant metastases. However, several aspects of the current classification are controversial. Based on the results of recent studies, the 2002 TNM edition will have to be revised to improve its prognostic power. Tumour size still represents one of the most important prognostic variables for RCC. The 4-cm cut-off point between pT1a and pT1b tumours might be increased and the interval between 5 and 6 cm seems to provide a better stratification of outcomes for organ-confined RCCs [2]. It is important to stress that these size thresholds have a prognostic value and should not be used as criteria to indicate or contraindicate nephron-sparing surgery. Tumour location in combination with tumour size should be assessed to decide whether a conservative approach is advisable for a localised tumour. Significant progress in the diagnosis, staging, and treatment of patients with renal cell carcinoma (RCC) has occurred in recent years. Surgery remains the standard of care for localised RCC. Nephronsparing surgery is increasingly favoured for small, organ-confined tumours. New minimally invasive techniques, such as cryoablation and radiofrequency ablation, have shown promising results, although the follow-up is still short. Active surveillance seems to be a reasonable treatment option for selected elderly patients with small tumours who are poor surgical candidates. Furthermore, today surgery has a role in the cytoreductive treatment of metastatic RCC, in conjunction with immunotherapy or, increasingly, new biologic-targeted therapies. These promising drugs are also being considered in an adjuvant setting after nephrectomy in patients at higher risk of local or systemic recurrence. Overall, the clinical management of RCC is changing and the urologist has an increasing need for accurate and reliable pathologic information on which to make treatment decisions, counsel patients about their prognosis, and determine appropriate follow-up schedules after treatment. The role of the pathologist is therefore increasingly important to optimise the management of RCC in all clinical stages. In the present issue of European Urology, Kirkali et al report the results of a joint meeting discussing