Editing Management of Localized and Locally Advanced Disease (section)

== Prognostic factors in Localized Disease ==

* '''Pathological risk factors for ipsilateral renal recurrence include (4):'''
*# '''T stage'''
*# '''Grade'''
*# '''Multifocality'''
*# '''Positive surgical margins (controversial)'''
* '''Pathological risk factors for disease relapse include (4):'''
** '''Pathologic stage (most important)'''
*** Most patients with direct or metastatic ipsilateral adrenal involvement, found in 1-2% of cases, eventually die due to systemic disease progression
*** 5-year OS by pT stage
**** pT1a: 90-100%
**** pT1b: 80-90%
**** pT2a: 65-80%
**** pT2b: 50-70%
**** pT3a: 40-70%
**** pT3b: 30-50%
**** pT3c: 20-40%
**** pT4: 0-30%
*** '''The presence of lymph node or distant metastases is associated with dismal prognosis'''
**** Median cancer-specific survival for pN1: 2.8 years
** '''Histological subtype'''
*** Significant predictor of survival and recurrence, regardless of type of surgical resection or tumour stage.
**** RCC with collecting duct carcinoma, medullary carcinoma, and tumour with elements of sarcomatoid and rhabdoid dedifferentiation exhibit higher metastatic potential.
**** Localized chromophobe and papillary RCC type 1 are associated with a better prognosis
** '''Grade'''
*** See Grade in Kidney Cancer: Pathology and Familial Syndromes
*** '''Higher Fuhrman grade is an independent prognostic factor for RCC generally and for ccRCC in particular'''
** '''Other prognostic factors:'''
*** '''Tumour size''' (independent prognostic factor, despite its correlation with stage)
*** '''Necrosis'''
*** '''Microvascular invasion'''
*** '''Sarcomatoid features'''
*** '''DNA ploidy'''
*** '''Collecting system invasion'''
* '''Clinical factors associated with prognosis:'''
*# '''Performance status (Eastern Cooperative Oncology Group [ECOG])'''
*# '''Presence of symptoms (localized or systemic)'''
*# '''Cachexia'''
*# '''Laboratory: anemia, platelet count, elevated erythrocyte sedimentation rate'''
** Although patient age and comorbidity are important predictors of overall survival in patients with RCC and strongly affect the choice of treatment in these patients, they have no effect on the likelihood of dying of cancer-specific causes.
* '''Prognostic Nomograms in Localized Kidney Cancer'''
** Developed to predict survival
** Stage, Size, Grade, and Necrosis '''(SSIGN) score''': tumour stage, size (≥5 cm), grade, and presence of necrosis
** University of California Los Angeles Integrated Staging System '''(UISS)''': tumour stage, grade, and Eastern Cooperative Oncology Group performance status
** '''Karakiewicz''': tumour stage, grade, and symptom classification (systemic vs. local vs. no symptoms at diagnosis)

* Molecular markers are not recommended in the routine clinical setting
* See prognostic factors for advanced disease in Advanced Kidney Cancer Chapter Notes