Type:
Educational Exhibit
Keywords:
Neoplasia, Multidisciplinary cancer care, Surgery, Structured reporting, CT, Kidney, Genital / Reproductive system male
Authors:
F. Rosa1, I. Verardo1, S. Barbagallo1, G. Perugin1, C. Martinetti2, L. Basso1, L. Secondini1, S. Sanguinetti1, C. E. Neumaier1; 1Genova/IT, 2Genoa/IT
DOI:
10.26044/ecr2019/C-1015
Background
In the last decades,
the treatments of RCC has significantly evolved: both new nephron-sparing surgical techniques and innovative systemic therapy in advanced RCC were developed.
Otherwise several authors have shown that RCC has an high recurrence rate (20~30%) after surgical treatment highlighting the need of prognostic factors [1,2,3].
For these reasons several revisions of TNM staging which reflects the advances in treatment and prognosis were made.
Major changes were made in the 7th edition of Tumor-Node-Metastasis (TNM) staging system regarding especially T3 category: renal vein invasion was down-staged from T3b to T3a and adrenal invasion was up-staged from T3a to T4 or M1.
The updated TNM (8th edition,
2017) staging is shown in Fig. 2 and variations applied are summarized in Fig. 3.
They concern always T3 category with clarification of T3a disease which involve renal vein and its tributaries: the world “grossly” to describe renal vein invasion was removed because tumoral vein involvement were missed especially in partial nephrectomy specimen.
Moreover,
involvement of pelvi-calyceal system is also added in T3a.
Infact,
the renal fat sinus is being recognised as key point for the extrarenal spread of disease.
Its involvement makes more worse prognosis than perinephric fat invasion.
Recognition of renal sinus infiltration prompted to change the clinical practice in the last years: presently,
renal sinus targeted samplings in nephrectomies are the rule.
Redefinition of T3a category have an impact especially on clinical trial for adjuvant chemotherapies.
In this clinical setting,
the information provided by radiologists plays a crucial role in guiding decisions regarding therapy.
The accurate use of a standardised report enables urologists and oncologists to plan treatment and determine prognosis.