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Volume 15, Issue 4 (July 2013) 15, 550–557; 10.1038/aja.2012.161

Application of the revised Tumour Node Metastasis (TNM) staging system of clear cell renal cell carcinoma in eastern China: advantages and limitations

Chao Qin1,*, Li-Jiang Sun2,*, Li Cui3, Qiang Cao1, Jian Zhu1, Pu Li1, Gui-Ming Zhang2, Xin Mao2, Peng-Fei Shao1, Mei-Lin Wang4, Zheng-Dong Zhang4, Min Gu1, Wei Zhang1 and Chang-Jun Yin1

1 Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
2 Department of Urology, The Affiliated Hospital of Medical College Qingdao University, Qingdao 266001, China
3 Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
4 Department of Molecular and Genetic Toxicology, School of Public Health, Nanjing Medical University, Nanjing 210029, China

* These authors contributed equally to this work.

Correspondence: Dr CJ Yin, (drcjyin@gmail.com); Dr W Zhang, (doctormn@163.com)

Received 27 September 2012; Revised 24 November 2012; Accepted 12 December 2012; Advance online publication 8 April 2013


This study was designed to evaluate whether the revised 2010 Tumour Node Metastasis (TNM) staging system could lead to a more accurate prediction of the prognosis of renal cell carcinoma (RCC) patients. A total of 1216 patients who had undergone radical nephrectomy or partial nephrectomy for RCC from 2003 to 2011 were enrolled. All of the patients had pathologically confirmed clear cell RCC (ccRCC). All cases were staged by both the 2002 and 2010 TNM staging systems after pathological review, and survival data were collected. Univariate and multivariate Cox regression models were used to evaluate cancer-specific survival (CSS) and progression-free survival (PFS) after surgery. Continuous variables, such as age and tumour diameter, were calculated as mean values and standard deviations (s.d.) or as median values. Survival was calculated by the Kaplan–Meier method, and the log-rank test assessed differences between groups. Statistically significant differences in CSS and PFS were noted among patients in T3 subgroups using the new 2010 staging system. Therefore, the revised 2010 TNM staging system can lead to a more accurate prediction of the prognosis of ccRCC patients. However, when using the revised 2010 staging system, we found that more than 92% of patients (288/313) with T3 tumours were staged in the T3a subgroup, and their survival data were not significantly different from those of patients with T2b tumours. In addition, T2 subclassification failed to independently predict survival in RCC patients.

Keywords: kidney neoplasm; prognosis; renal cell carcinoma; TNM stage

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Asian Journal of Andrology CN 31-1795/R ISSN 1008-682X  Copyright © 2023  Shanghai Materia Medica, Chinese Academy of Sciences.  All rights reserved.