Tumours of the kidney are one of the common genitourinary malignancies.A detailed and meticulous histopathological examination of nephrectomy specimens is essential to record accepted Pathological prognostic factors. This study was undertaken to study prognostic value of histological subtypes and pTNM stage and grade of the malignant renal tumor. Nephrectomy specimen from 36 patients were studied. Patient’s clinical details, preoperative imaging and surgical details were reviewed. Each specimen was staged according to the 2017 AJCC TNM staging. Nuclear grade was assigned according to the revised WHO/ISUP grade.

Statistical Methods: Statistical analysis was performed using statistical software and descriptive statistics and survival functions were obtained by Kaplan- Meier product limit method. Univariate and multivariate analysis of factors affecting outcome of the patient were performed. Factors that were found to be significant on Univariate analysis were then subjected to multivariate analysis by Cox proportional hazards regression model

Results: Mean follow up period was 26.3 months (range 3 to 63 months). Univariate analysis revealed that histologic types stage and grade were statistically significant (P=0.009,0.007 and 0.003 respectively). Multivariate analysis model revealed that ISUP nuclear grade and stage were statistically significant (P=0.007 and 0.002 respectively).

Conclusion: This study emphasizes the pathological pTNM (AJCC) 2017 staging as having significant survival impact in the patients of Renal Cancer in the Indian subpopulation. In these patients Histologic subtype and nuclear  WHO/ISUP grade are important independent predictors of survival.Organ confined tumours with high nuclear grades need to be followed up more rigorously.

Keywords: Renal Cell carcinoma, Radical Nephrectomy, pTNM staging, ISUP grading, prognostic factors.

1. Robson CJ, Churchill BM, Anderson W. Results of radical nephrectomy for renal cell carcinoma. J Urol;101:297-301,1969.
2. Van Brussel JP, Mickisch GH. Prognostic factors in renal cell and bladder cancer. Br J Urol Int;83:902-9.1999
3. Bonsib SM. Risk and prognosis in renal neoplasms. A pathologist’s prospective. Urol Clin North Am;26:643-60. Review.1999
4. Medeiros LJ, Gelb AB, Weiss LM. Renal cell carcinoma. Prognostic significance of morphologic parameters in 121 cases. Cancer;61:1639-51,1988.
5. Guinan P, Sobin LH, Algaba F, Badellino F, Kameyama S, MacLennan G, et al. TNM staging of renal cell carcinoma: Workgroup No. 3. Union International Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer;80:992-3,1997.
6. Bretheau D, Lechevallier E, de Fromont M, Sault MC, Rampal M, Coulange C. Prognostic value of nuclear grade of renal cell carcinoma Cancer;76:2543,1995.
7. Delahunt B, Cheville JC, Martignoni G et al The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters. Am J SurgPathol 37:1490–1504.2013
8. Moch H, Humphrey PA, Ulbright TM, Reuter VE (2016) WHO classification Tumours of the urinary system and male genital organs. International Agency for Research on Cancer, Lyon Moch H, Gasser T, Amin MB, Torhorst J, Sauter G, Mihatsch MJ. Prognostic utility of the recently recommended histologic classification and revised TNM staging system of renal cell carcinoma: A Swiss experience with 588 tumors. Cancer;89:604-14.2000.
9. Nativ O, Sabo E, Raviv G, Madjar S, Halachmi S, Moskovitz B. The impact of tumor size on clinical outcome in patients with localized renal cell carcinoma treated by radical nephrectomy. J Urol;158:729-32,1997.
10. Yoshino S, Kato M, Okada K. Evaluation of the prognostic signifi- Srivastava et al: Prognostic factors in patients with renal cell carcinoma Indian Journal of Cancer | July - September 2004 | Volume 41 | Issue 3 103 cance of microvessel count and tumor size in renal cell carcinoma. Int J Urol:119-23,1985.
11. Hafez KS, Fergany AF, Novick AC. Nephron sparing surgery for localized renal cell carcinoma:impact of tumor size on patient survival, tumor recurrence and TMN staging. J Urol;162:1930-3,1999.
12. Delahunt B, McKenney JK, Lohse CM, Leibovich BC, Thompson RH, Boorjian SA, Cheville JC A novel grading system for clear cell renal cell carcinoma incorporating tumor necrosis. Am J SurgPathol 37:311–322(2013)
13. Zisman A, Pantuck AJ, Chao D, Dorey F, Said JW, Gitlitz BJ, et al. Reevaluation of the 1997 TNM classification for renal cell carcinoma: T1 and T2 cutoff point at 4.5 cm rather than 7 cm better correlates with clinical outcome. J Urol;166:54-8,2001
14. Patard JJ, Leray E, Rioux-Leclercq N, Cindolo L et al Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J ClinOncol 23:2763–2771,2005.
15. Leibovich BC, Lohse CM, Crispen PL, Boorjian SA, Thompson RH, BluteML, Cheville JC Histological subtype is an independent predictor of outcome for patients with renal cell carcinoma. J Urol 183:1309–1315,2010.
16. Capitanio U, Cloutier V, Zini L et al A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study. BJUI 103:1496–1500,2009.
17. Volpe A, Novara G, Antonelli A et al Chromophobe renal cell carcinoma (RCC): oncological outcomes and prognostic factors in a large multicentre series. BJU Int 110:76–83,2012.
18. Frees S, Kamal MM, Knoechlein L et al Differences in overall and cancer-specific survival of patients presenting with chromophobe versus clear cell renal cell carcinoma: a propensity score matched analysis. Urology. Doi 10. 1016/ j .urology.2016.05.048,2016.

19. Amin MB, Paner GP, Alvarado-Cabrero I, Young AN, Stricker HJ, Lyles RH, Moch H Chromophobe renal cell carcinoma: histomorphologic characteristics and evaluation of conventional pathologic prognostic parameters in 145 cases. Am J Surg Pathol32:1822–1834,2008.
20. Becker A, Hickmann D, Hansen J et al Critical analysis of a simplified Fuhrman grading scheme for prediction of cancer specific mortality in patients with clear cell renal cell carcinoma–impact on prognosis. Eur J Surg Oncol 42:419–425,2016.
21. Lang H, Jacqmin D. Prognostic factors in renal cell carcinoma. EAU update series; 1:215-9,2003.
22. Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: An analysis of pathological features related to tumor size. J Urol;170:2217-20,2003.
23. Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score. J Urol 168:2395–2400,2002.

Dr Sanjay Nanaji Parate

Department of Pathology, Government Medical College and Superspeciality Hospital, Nagpur, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.