The Influence of Clinical and Pathological Stage Discrepancy on Cancer Specific Survival in Patients Treated for Renal Cell Carcinoma

Purpose: We compared clinical and pathological staging in a contemporary, consecutive series of patients treated with partial or radical nephrectomy for renal cell carcinoma and we determined the effect of clinical and pathological stage discrepancy on outcomes. Materials and Methods: We collected retrospective clinical, pathological and survival data on 264 consecutive patients with clinical T1-3 renal cell carcinoma who were treated with laparoscopic or open partial or radical nephrectomy at a single institution from 1994 to 2003. Results: Pathological up staging occurred in 44 of 264 patients (17%) patients. Of 135 clinical T1 tumors 25 (18.5%) and 18 of 85 (21.2%) clinical T2 tumors were pathologically up staged. Patients with clinical T1 and T2 tumors were stratified into 2 groups, including those with the same clinical and pathological stage, and those with pathological up staging. Mean 5-year recurrence-free survival ± SD for same stage vs pathologically up staged clinical T1 (84.3% ± 4.4% vs 47.4% ± 11.5%) and clinical T2 (80.0% ± 6.8% vs 40.7% ± 13.4%) tumors was significantly different (p <0.0002). Five-year cancer specific survival for same stage vs pathologically up staged clinical T1 tumors was significantly different (98.5% ± 1.5% vs 69.7% ± 11.3%, p = 0.0005), while that for clinical T2 tumors approached clinical significance (90.9% ± 5.0% vs 72.7% ± 13.4%, p = 0.0501). Conclusions: Stage discrepancy is common in surgically treated patients diagnosed with renal masses and it has a significant impact on clinical outcome. Implications of such clinical and pathological stage discrepancy should be considered when counseling patients and determining therapeutic approaches.