Korean J Urol.  2011 Aug;52(8):524-530. 10.4111/kju.2011.52.8.524.

Validation of the 2009 TNM Classification for Renal Cell Carcinoma: Comparison with the 2002 TNM Classification by Concordance Index

• Lee C
• You D
• Park J
• Jeong IG
• Song C
• Hong JH
• Ahn H
• Kim CS

• KMID: 1988956
• DOI: http://doi.org/10.4111/kju.2011.52.8.524

Abstract

PURPOSE
To assess the validity of the 2009 TNM classification for renal cell carcinoma (RCC) and compare its ability to predict survival relative to the 2002 classification.
MATERIALS AND METHODS
We identified 1,691 patients who underwent radical nephrectomy or partial nephrectomy for unilateral, sporadic RCC between 1989 and 2007. Cancer-specific survival was estimated by the Kaplan-Meier method and was compared among groups by the log-rank test. Associations of the 2002 and 2009 TNM classifications with death from RCC were evaluated by Cox proportional hazards regression models. The predictive abilities of the two classifications were compared by using Harrell's concordance (c) index.
RESULTS
There were 234 deaths from RCC a mean of 38 months after nephrectomy. According to the 2002 primary tumor classification, 5-year cancer-specific survival was 97.6% in T1a, 92.0% in T1b, 83.3% in T2, 61.9% in T3a, 51.1% in T3b, 40.0% in T3c, and 33.6% in T4 (p for trend<0.001). According to the 2009 classification, 5-year cancer-specific survival was 83.2% in T2a, 83.8% in T2b, 62.6% in T3a, 41.1% in T3b, 50.0% in T3c, and 26.1% in T4 (p for trend<0.001). The c index for the 2002 primary tumor classification was 0.810 in the univariate analysis and increased to 0.906 in the multivariate analysis. The c index for the 2009 primary tumor classification was 0.808 in the univariate analysis and increased to 0.904 in the multivariate analysis.
CONCLUSIONS
Our data suggest that the predictive ability the 2009 TNM classification is not superior to that of the 2002 classification.

Keyword

Kidney neoplasms; Mortality; Neoplasm staging; Prognosis; Renal cell carcinoma

MeSH Terms

Carcinoma, Renal Cell
Humans
Kidney Neoplasms
Multivariate Analysis
Neoplasm Staging
Nephrectomy
Prognosis

Figure

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  FIG. 1 Cancer-specific survival according to the 2002 (A) and 2009 (B) primary tumor classifications.

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  FIG. 2 Cancer-specific survival according to the 2002 lymph node classification.

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