Renal Cell Carcinoma Specific Survival Research Articles

RAMPART: A phase III multi-arm multi-stage trial of adjuvant checkpoint inhibitors in patients with resected primary renal cell carcinoma (RCC) at high or intermediate risk of relapse

Background20–60% of patients with initially locally advanced Renal Cell Carcinoma (RCC) develop metastatic disease despite optimal surgical excision. Adjuvant strategies have been tested in RCC including cytokines, radiotherapy, hormones and oral tyrosine-kinase inhibitors (TKIs), with limited success. The predominant global standard-of-care after nephrectomy remains active monitoring. Immune checkpoint inhibitors (ICIs) are effective in the treatment of metastatic RCC; RAMPART will investigate these agents in the adjuvant setting. Methods/designRAMPART is an international, UK-led trial investigating the addition of ICIs after nephrectomy in patients with resected locally advanced RCC. RAMPART is a multi-arm multi-stage (MAMS) platform trial, upon which additional research questions may be addressed over time. The target population is patients with histologically proven resected locally advanced RCC (clear cell and non-clear cell histological subtypes), with no residual macroscopic disease, who are at high or intermediate risk of relapse (Leibovich score 3–11). Patients with fully resected synchronous ipsilateral adrenal metastases are included. Participants are randomly assigned (3,2:2) to Arm A - active monitoring (no placebo) for one year, Arm B - durvalumab (PD-L1 inhibitor) 4-weekly for one year; or Arm C - combination therapy with durvalumab 4-weekly for one year plus two doses of tremelimumab (CTLA-4 inhibitor) at day 1 of the first two 4-weekly cycles. The co-primary outcomes are disease-free-survival (DFS) and overall survival (OS). Secondary outcomes include safety, metastasis-free survival, RCC specific survival, quality of life, and patient and clinician preferences. Tumour tissue, plasma and urine are collected for molecular analysis (TransRAMPART). Trial registrationISRCTN #: ISRCTN53348826, NCT #: NCT03288532, EUDRACT #: 2017–002329-39, CTA #: 20363/0380/001–0001, MREC #: 17/LO/1875, ClinicalTrials.gov Identifier: NCT03288532, RAMPART grant number: MC_UU_12023/25, TransRAMPART grant number: A28690 Cancer Research UK, RAMPART Protocol version 5.0.

Purely off‐clamp robotic partial nephrectomy: Preliminary 3‐year oncological and functional outcomes

To describe our surgical technique and to report perioperative, 3-year oncological and functional outcomes of a single-center series of purely off-clamp robotic partial nephrectomy. A prospective renal cancer institutional database was queried, and data of consecutive patients treated with purely off-clamp robotic partial nephrectomy between 2010 and 2015 in a high-volume center were collected. Perioperative complications, and 3-year oncological and functional outcomes were assessed. Univariable and multivariable analyses were carried out to identify independent predictors of renal function deterioration. Out of 308 patients treated, 41 (13.3%) experienced perioperative complications, 2.9% of which were Clavien grade≥3. The 3-year local recurrence-free survival and renal cell carcinoma-specific survival rates were 99.5% and 97.9%, respectively. No patient with preoperative chronic kidney disease stage≤3B developed severe renal function deterioration (chronic kidney disease stage4) at 1-year follow up. At multivariable analysis, preoperative estimated glomerular filtration rate (P=0.005) was the only independent predictor of a new-onset chronic kidney disease stage≥3 in patients with preoperative chronic kidney disease stages1 or 2. Off-clamp robotic partial nephrectomy is a safe surgical approach in tertiary referral centers, with adequate oncological outcomes and negligible impact on renal function.

Loss of histone H3 lysine 36 trimethylation is associated with an increased risk of renal cell carcinoma-specific death

Sequencing of clear cell renal cell carcinomas identified loss-of-function mutations of SETD2, a gene that encodes a nonredundant methytransferase responsible for histone H3 lysine 36 trimethylation (H3K36me3), and H3K36me3 is progressively deregulated in metastases. However, few data exist regarding the impact of loss of H3K36me3 on outcomes. We assessed the association of SETD2 DNA alterations and mRNA expression with overall survival using The Cancer Genome Atlas clear cell renal carcinoma data (N=411). Additionally, we assessed the association of H3K36 loss of methylation with renal cell carcinoma-specific survival and progression-free survival using an independent cohort at Mayo Clinic (N=1454). Overall survival, renal cell carcinoma-specific survival and progression-free survival were estimated using Kaplan–Meier method, and differences in survival across groups was compared using Cox regression models, adjusted for age and the Mayo SSIGN (stage, size, grade, and necrosis) score. In The Cancer Genome Atlas cohort, SETD2 DNA alterations or mRNA expression was not associated with overall survival (P>0.05). In the Mayo cohort, patients with H3K36me3-negative tumors were two times more likely to experience renal cell carcinoma-specific death than patients with H3K36me3-positive tumors (hazard ratio, 2.23; 95% confidence interval, 1.77–2.81); P<0.0001. After stratifying for the SSIGN score, H3K36me3-negative tumors in the low-risk SSIGN group had a worse renal cell carcinoma-specific survival (hazard ratio, 2.18; 95% confidence interval, 1.09–4.36); P=0.03. Although SETD2 DNA and mRNA alterations are not associated with overall survival, we provide evidence that deregulation of the H3K36me3 axis is associated with a higher risk of renal cell carcinoma-specific death. This association remains significant after stratifying for the SSIGN score, particularly among those patients with low-risk tumors.

Loss of BAP1 and PBRM1 protein expression and its association with clear cell renal cell carcinoma-specific survival.

414 Background: While mutations in PBRM1 (~40%) and BAP1(~10%) are associated with clinical outcomes and pathologic features in clear cell renal cell carcinoma (ccRCC), the impact of protein expression of these genes remains unknown. Herein, we quantify PBRM1/BAP1 protein expression in a large cohort of patients with localized ccRCC and associate expression with cancer-specific survival (CSS) and pathologic features. Methods: We utilized the Mayo Clinic Renal Registry and identified 1,416 patients who underwent nephrectomy to treat clinically localized ccRCC between 1/3/1990 and 4/14/2009. We used immunohistochemistry (IHC) to detect PBRM1/BAP1 expression, and a central pathologist blinded to the outcomes scored tumors as either positive or negative. Tumors with heterogeneous or equivocal staining were excluded from this analysis. We generated Cox proportional hazard regression models for associations with ccRCC-SS, and we employed Mann-Whitney U tests for associations with pathologic features. Results: Of the 1,416 samples, 1,232 (87%) were PBRM1/BAP1 positive or negative, 163 (11%) had heterogeneous staining, and 21 (1%) could not be assessed. The distribution and association of PBRM1/BAP1 phenotypes with clinical outcomes are listed in the table below. PBRM1+/BAP1+ tumors have the best CSS, and PBRM1-/BAP1- have the worst. In addition, PBRM1/BAP1 expression strongly associated with the tumor size, stage, grade, and tumor necrosis (p&lt;0.0001). Conclusions: This study is the first and largest to quantify PRBM1/BAP1 protein expression in ccRCC tumors. We were able to quantify PBRM1/BAP1 through IHC in the vast majority of tumors (87%), and PRBM1/BAP1 expression strongly associates with both CSS and pathologic tumor characteristics. Our data confirms our previous findings of the importance of PRBM1/BAP1 in the molecular pathogenesis of ccRCC. [Table: see text]

1831 THE NUMBER OF LYMPH NODES REMOVED IN RENAL CELL CARCINOMA DOES AFFECT CANCER SPECIFIC SURVIVAL IN SPECIFIC SUBGROUPS OF PATIENTS: RESULTS FROM A SYSTEMATIC ANALYSIS

INTRODUCTION AND OBJECTIVES: Although the EORTC prospective trial failed to demonstrate a significant benefit of lymph node dissection (LND) on renal cell carcinoma specific survival (CSS), some retrospective reports suggested that LND might be beneficial in presence of unfavourable conditions. We systematically tested the effect of the number of lymph nodes removed on cancer specific survival (CSS). METHODS: Patient records were prospectively retrieved and yielded 1983 RCC patients treated with partial or radical nephrectomy between 1987 and 2012 at a single tertiary care institution. TNM stages were assigned according to the 2009 AJCC/UICC classification. Cases before the introduction of the most updated classification were reclassified. Univariable and multivariable Cox regression analyses targeted the effect of the number of lymph nodes removed on CSS. Since the number of nodes removed may be influenced by patients and tumor characteristics, analyses were further adjusted for number of positive nodes, patient age, pathological T stage, ECOG performance status, metastases at diagnosis, pathological tumor size, Fuhrman grade, presence of necrosis and sarcomatoid features. RESULTS: Pathological nodal status resulted pN0, pN1 and pNx in 758 (38.0%), 120 (6.1%) and 1109 (55.9%) cases, respectively. When LND was performed, the mean number of nodes removed was 7.8 (median 6, range 1-58). Mean follow up was 74.4 months (median 54.2). CSS rates at 1, 5 and 10 years resulted 57.9, 22.1 and 15.4% vs. 94.3, 78.4 and 70.8% vs. 96.9, 92.3 and 89.1% for pN1 vs. pN0 vs. pNx cases, respectively. At multivariable analyses, after adjusting for all the potential confounders, the number of nodes removed showed an independent, protective effect on CSS in patients with larger tumors (pT2a-pT2b, hazard ratio [HR] 0.91, p 0.008), locally advanced disease with extension to vena cava wall or above the diaphragm (pT3c, HR 0.86, p 0.008), tumors invading beyond Gerota fascia (pT4, HR 0.84, p 0.007) or when sarcomatoid features were found (HR 0.81, p 0.006). CONCLUSIONS: When clinically indicated, LND and its extent, namely the number of nodes removed, independently affect survival in specific subgroups of patients. Specifically, LND extent seems to affect CSS in those cases which show lymph node trophism or with the highest risk of lymph node invasion (larger tumors, locally advanced disease with extension to vena cava wall or above the diaphragm, tumors invading beyond Gerota fascia or when sarcomatoid features are found).

Outcomes of Patients with Surgically Treated Bilateral Renal Masses and a Minimum of 10 Years of Followup

Nephron sparing surgery has been advocated for patients with bilateral renal masses but long-term functional and oncological outcomes are lacking. We report the outcomes of patients with bilateral renal masses and a minimum 10-year followup. Patients with bilateral renal masses evaluated at our institution who were treated with initial surgery at least 10 years ago and underwent interventions on each renal unit were included in the analysis. Collected data included demographics, hereditary diagnosis, number of renal interventions, renal function and mortality status. Overall and renal cell carcinoma specific survival was assessed. Comparisons were made of renal function and overall survival between groups with 2 renal units and a surgically solitary kidney. A total of 128 patients met study inclusion criteria. Median followup in our cohort was 16 years (mean 17, range 10 to 49). The median number of surgical interventions was 3 (range 2 to 10). Of the patients 87 (68%) required repeat interventions on the ipsilateral renal unit at last followup with a median of 6.2 years (range 0.7 to 21) between interventions. Overall and renal cell cancer specific survival was 88% and 97%, respectively. Six patients (4.7%) ultimately underwent bilateral nephrectomy. Although renal function was better preserved in patients with 2 kidneys (70 vs 53 ml/minute/1.73 m(2), p = 0.0002), there was no difference in overall survival between those with bilateral kidneys or a surgically solitary kidney. At a minimum 10-year followup after initial surgery, nephron sparing surgery allowed for excellent oncological and functional outcomes. Despite the need for repeat surgical interventions, nephron sparing surgery enabled dialysis to be avoided in more than 95% of patients.

Absent Toll-like receptor-9 expression predicts poor prognosis in renal cell carcinoma

BackgroundToll-like receptor 9 (TLR9) is a cellular DNA-receptor whose activation with cognate ligands triggers an immune reaction, with increased production of inflammatory cytokines. The aim of this study was to examine the expression of TLR9 in renal cell carcinoma (RCC), which is generally renowned of its immunogenic nature. We also evaluated the prognostic value of TLR9 in RCC.MethodsTLR9 expression in RCC was characterized with immunohistochemistry in a retrospective study population of 152 RCC patients who underwent renal surgery. The TLR9 staining intensity was compared with clinical parameters.ResultsOf the studied tumours, 112 (81%) exhibited cytoplasmic TLR9 immunostaining. No association was detected between cytoplasmic TLR9 immunoexpression intensity and stage, nuclear grade, histological subtype or tumour necrosis. Cytoplasmic TLR9 immunoexpression was, however, a marker of favourable RCC specific survival both in univariate analysis and in multivariate regression model.ConclusionsWe conclude that TLR9 expression is an independent prognostic marker of RCC and the absence of TLR9 expression is related to poorer prognosis in RCC.

Conditional Survival Predictions After Nephrectomy for Renal Cell Carcinoma

Conditional survival implies that on average long-term cancer survivors have a better prognosis than do newly diagnosed individuals. We explored the effect of conditional survival in renal cell carcinoma. We studied 3,560 patients with renal cell carcinoma of all stages treated with nephrectomy. We applied conditional survival methodology to a previously reported posttreatment nomogram predicting survival after nephrectomy for patients with renal cell carcinoma stage I to IV. We used the same predictor variables that were integrated in the original multivariable Cox regression models, namely TNM stage, Fuhrman grade, tumor size and symptom classification. To validate the conditional survival nomogram we used an independent cohort of 3,560 patients from 15 institutions. The 5-year survival of patients immediately after nephrectomy was 74.2%, which increased to 80.4%, 85.1%, 90.6% and 89.6% at 1, 2, 5 and 10 years after nephrectomy, respectively. The predicted probabilities varied by as much as 50% when, for example, predictions of renal cell carcinoma specific mortality at 10 years were made after nephrectomy vs 5 years later. Within the external validation cohort the accuracy of the conditional nomogram was 89.5%, 90.5%, 88.5% and 86.7% at 1, 2, 5 and 10 years after nephrectomy. We developed (2,530) and externally validated (3,560) a conditional nomogram for predicting renal cell carcinoma specific mortality that allows consideration of the length of survivorship. Our tool provides the most realistic prognosis estimates with high accuracy.

Location of Extrarenal Tumor Extension Does Not Impact Survival of Patients With pT3a Renal Cell Carcinoma

The current TNM classification for pathological pT3a renal cell carcinoma includes patients with perinephric or sinus fat invasion, suggesting that the prognoses are similar for these pathological findings. However, sinus fat invasion was proposed by some investigators to be an independent predictor of inferior cancer specific outcome following surgical treatment. To assess and improve the predictive ability of the current pT3a primary tumor classification we evaluated the prognostic significance of location of extrarenal tumor extension on cancer specific survival following surgery. The database of 3,470 patients at our institution who were treated for renal cell carcinoma from 1990 to 2006 was searched for those with pT3a tumors managed by partial or radical nephrectomy. Patients with nonrenal cell carcinoma histology, direct adrenal invasion or a followup of less then 6 months were excluded from analyses. The prognostic importance of all clinical and pathological variables was investigated using Cox proportional hazards regression. A total of 365 patients with pT3a renal cell carcinoma and a mean followup of 33.5 months (range 6.1 to 158.6) met study inclusion criteria and they comprise the data set for this analysis. There was no difference in 5-year cancer specific survival between 166 patients (45.5%) with SF invasion and 199 (54.5%) with PF invasion only (50.8% and 54.1%, p = 0.782 respectively). On univariate analyses neither sinus fat invasion nor the location of extrarenal extension, assessed as perinephric fat vs sinus fat vs perinephric plus sinus fat, correlated with cancer specific survival following surgical treatment (HR 1.052, p = 0.783 and HR 1.072, p = 0.543, respectively). After adjusting for the effects of nodal and systemic metastases tumor grade and sarcomatoid differentiation remained independent predictors of renal cell carcinoma specific survival in our pT3a cohort of patients (HR 1.508, p = 0.003 and HR 1.810, p = 0.018, respectively). In contrast to previously reported observations, in our cohort of surgically treated patients with pT3a renal cell carcinoma the location of extrarenal extension was not an important prognosticator of cancer specific mortality. Based on our findings we confirm that perinephric and/or sinus fat should be similarly subclassified in the primary tumor staging system.

1246: Nephron-Sparing Surgery does not Undermine Renal Cell Carcinoma-Specific Survival in Patients with PT3 Renal Cell Carcinoma

You have accessJournal of UrologyModerated Poster 37, Tuesday, May 22, 2007, 8:00 - 10:00 am1 Apr 20071246: Nephron-Sparing Surgery does not Undermine Renal Cell Carcinoma-Specific Survival in Patients with PT3 Renal Cell Carcinoma Quoc-Dien Trinh, Pierre I. Karakiewicz, Naeem Bhojani, Vincent Fournier-Cloutier, Georg C. Hutterer, Maxime Crepel, John S. Lam, Francois Guille, Baptiste Albouy, Michel Soulie, Laurent Bellec, David Lopes, Christian Pfister, Jean-Christophe Bernhard, Bertrand Lacroix, Jacques Tostain, Jean-Marie Ferriere, Clément-Claude Abbou, Marc Colombel, Arie S. Belldegrun, Laurent Salomon, Alexandre De La Taille, Allan J. Pantuck, and Jean-Jacques Patard Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Vincent Fournier-CloutierVincent Fournier-Cloutier More articles by this author , Georg C. HuttererGeorg C. Hutterer More articles by this author , Maxime CrepelMaxime Crepel More articles by this author , John S. LamJohn S. Lam More articles by this author , Francois GuilleFrancois Guille More articles by this author , Baptiste AlbouyBaptiste Albouy More articles by this author , Michel SoulieMichel Soulie More articles by this author , Laurent BellecLaurent Bellec More articles by this author , David LopesDavid Lopes More articles by this author , Christian PfisterChristian Pfister More articles by this author , Jean-Christophe BernhardJean-Christophe Bernhard More articles by this author , Bertrand LacroixBertrand Lacroix More articles by this author , Jacques TostainJacques Tostain More articles by this author , Jean-Marie FerriereJean-Marie Ferriere More articles by this author , Clément-Claude AbbouClément-Claude Abbou More articles by this author , Marc ColombelMarc Colombel More articles by this author , Arie S. BelldegrunArie S. Belldegrun More articles by this author , Laurent SalomonLaurent Salomon More articles by this author , Alexandre De La TailleAlexandre De La Taille More articles by this author , Allan J. PantuckAllan J. Pantuck More articles by this author , and Jean-Jacques PatardJean-Jacques Patard More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31460-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1246: Nephron-Sparing Surgery does not Undermine Renal Cell Carcinoma-Specific Survival in Patients with PT3 Renal Cell Carcinoma." The Journal of Urology, 177(4S), p. 411 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 411 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Quoc-Dien Trinh More articles by this author Pierre I. Karakiewicz More articles by this author Naeem Bhojani More articles by this author Vincent Fournier-Cloutier More articles by this author Georg C. Hutterer More articles by this author Maxime Crepel More articles by this author John S. Lam More articles by this author Francois Guille More articles by this author Baptiste Albouy More articles by this author Michel Soulie More articles by this author Laurent Bellec More articles by this author David Lopes More articles by this author Christian Pfister More articles by this author Jean-Christophe Bernhard More articles by this author Bertrand Lacroix More articles by this author Jacques Tostain More articles by this author Jean-Marie Ferriere More articles by this author Clément-Claude Abbou More articles by this author Marc Colombel More articles by this author Arie S. Belldegrun More articles by this author Laurent Salomon More articles by this author Alexandre De La Taille More articles by this author Allan J. Pantuck More articles by this author Jean-Jacques Patard More articles by this author Expand All Advertisement PDF downloadLoading ...

ECOG performance status 0 or 1 and symptom classification do not improve the ability to predict renal cell carcinoma-specific survival

Objectives We tested and compared the improvement in prognostic ability related to the consideration of either ECOG performance status (ECOGPS) and/or symptom classification (S-CLASS) in renal cell carcinoma specific mortality (RCC-SM) predictions. Methods Univariate and multivariate Cox regression analyses targeted RCC-SM in 2570 RCC patients treated with either partial or radical nephrectomy. The increment in predictive accuracy related to the addition of either ECOGPS, S-CLASS or both was quantified using Harrell’s concordance index. Results Follow-up ranged from 0.1 to 23 years (median 3.2) and 610 patients (23.7%) died of RCC. In multivariable analyses, ECOGPS and S-CLASS represented independent predictors of RCC-SM. The addition of ECOGPS to established RCC-SM predictors increased the predictive accuracy by 0.3% ( p = 0.8) versus 0.6% ( p = 0.5) for S-CLASS versus 0.6% ( p = 0.5) for both. Conclusions Neither ECOGPS nor S-CLASS improves the ability to predict RCC-SM. Therefore, these variables may be safely omitted when RCC-SM risk is quantified.

Renal Cell Carcinoma with Nodal Metastases in the Absence of Distant Metastatic Disease: Prognostic Indicators of Disease-Specific Survival

ObjectivesOutcome of patients with exclusive renal cell carcinoma (RCC) nodal metastases without distant metastases is not extensively described. We explored the ability of standard risk factors such as tumour size, Fuhrman grade, histologic subtype and symptom classification to predict renal cell carcinoma-specific survival (RCC-SS). MethodsAnalyses targeted 171 patients with RCC nodal metastases and absence of distant metastases. Univariable, multivariable, and predictive accuracy analyses addressed RCC-SS with the intent of identifying independent and most informative predictors of RCC-SS in this cohort of patients. ResultsMedian RCC-SS was 2.3 yr. Symptom classification (61.3%, p<0.001) demonstrated the highest univariable accuracy. In multivariable analyses, symptom classification contributed the most to the combined predictive accuracy of all variables (+4.2%, p<0.001), followed by Fuhrman grade (+2.3%) and histologic subtype (+1.0%). ConclusionsRenal cell carcinoma-specific survival of patients with exclusive nodal metastases may show important variability. In presence of systemic symptoms, survival is extremely poor. Substantially better survival may be expected in patients with local or no symptoms. This observation has important implications when adjuvant therapies are considered.

Análisis de supervivencia de los carcinomas de células renales órgano-confinados. Valor pronóstico de la clasificación TNM 1997

Backgroundthe 5th edition of TNM classification for renal cell carcinoma changed the cut-off point of the tumor size for localized tumors, achieving a better distribution of patients with similar survival. Nevertheless, because of the variable evolution of renal cell carcinoma, the prognostic significance of tumor size is questioned as a staging criterion in organ-confined renal cell carinoma. We analyse renal cell carcinoma specific survival and the prognostic significance of tumor size in I and II stage. MethodsWe made a retrospective study with 158 renal cell carcinoma surgically treated in our hospital along 12 years. It was created a data base with clinical variables from patient and tumor and analyzed pathological staging, nuclear grade and specific survival, overall stage I and II. Results27 renal cell carcinoma were pT1 (17.08%), 52 pT2 (32.91%), 45 pT3A (28.45%), 10 pT3B (6.32%), y 24 pT4 (15.18%). The specific survival at 5 years for pT1-pT2, I-II stage, was 100% and 94% respectively, and no statistic significant differences were found between stage I and II (log-rank test 0.53, p>0.05). The specific survival at 5 years for pT3A, pT3B, y pT4 was 76.5%, 66.6% y 38.4%. There was a significant difference in survival in accordance with the tumor location, intrarenal (T1 y T2) versus extrarenal (T3A, T3B, T4) (log-rank test 9.06, p < 0.05). According to nuclear grade we don’t find significant differences for pT1 y pT2 (Fisher test, p=1). Regarding the relation between pT stage and nuclear grade of the tumor we obtained a ?2 inear tendency of 38.19, p < 0.001. ConclusionThe differences in the evolution of the organ-confined renal cell carcinoma with respect to the tumor size may be due to other molecular and biological variables, probably associated with stage. not controlled in essays. The TNM classification for organ-confined renal cell carcinoma based in tumor size seems artificial. New revisions of the classification system are necessary to identify which organ-confined carcinoma will have unfavourable evolution and to include them in a different category.

Prognosis After Nephrectomy for Renal Cell Carcinoma

During the period 1977-1988 177 males and 81 females (age 28-87 years) had nephrectomy performed for renal cell carcinoma. The most frequent symptoms were flank pain (54%) and hematuria (53%). Few patients (6%) had the classical triad of symptoms. Overall survival at 2 and 5 years were 0.55 and 0.41. Renal cell carcinoma specific survival were 0.59 and 0.49. Univariate analyses showed that increasing T stage, positive N or M stage, increasing stage according to Robson, hypersedimentation, anaemia and perioperative blood transfusion had a significant detrimental influence on survival. Multivariate analysis showed that simple Robson stage gave a simpler and equally good description as did the TNM stage. In the Cox multiple regression analysis Robson stage and ESR were the only statistically significant variables.