Dall'Oglio MF et al. (2007) Microvascular tumor invasion, tumor size and Fuhrman grade: a pathological triad for prognostic evaluation of renal cell carcinoma. J Urol 178: 425–428

A group of Brazilian researchers have identified a triad of pathological features to be used in the prognostic evaluation of patients with renal cell carcinoma (RCC).

Because of the variable natural history of RCC, the clinical outcome of patients with this disease can be difficult to predict. In light of recent developments in our knowledge of RCC, there is a need for new algorithms to help clinicians to improve patient care.

Dall'Oglio and colleagues from the University of São Paulo retrospectively analyzed data from 230 patients who were surgically treated for non-metastatic RCC (stages T1–4 Nx M0) at their institution between 1988 and 2003. Patients underwent either open radical nephrectomy or conservative surgery. Pathological analysis of tumor specimens was performed by a single pathologist.

Univariate and multivariate analyses were used to determine the prognostic impact of clinical presentation, histological type, Fuhrman grade, tumor size, lymph node involvement, and the presence of microvascular invasion on clinical outcomes, and to stratify patients according to risk of progression.

Median follow-up was 48 months (range 3–140 months). The recurrence and cancer-specific mortality rates were 17% and 13%, respectively. Tumor grade, tumor size, and microvascular invasion were the only independent predictors of survival on multivariate analysis. Disease-free survival was 94.7%, 56.8% and 13.1%, and cancer-specific survival was 94.7%, 61.7% and 32.0%, for low, intermediate, and high-risk tumors, respectively.

These findings might help clinicians to tailor treatment to individual patients.