Prognostic factors for localized renal cell carcinoma

Localized renal cell carcinoma (RCC) is a disease process which covers a wide spectrum of oncologic outcomes and depends on a variety of prognostic factors. These factors can be grossly categorized as clinical, anatomic, histopathologic, or molecular. Clinical factors include signs/symptoms, demographics, performance status, and abnormal laboratory values. Anatomic factors include tumor size and stage with consideration of venous involvement, extension into contiguous organs, and potential risk of lymph node metastases or micrometastatic disease. Histopathologic factors include histologic subtype, nuclear grade, sarcomatoid features, presence of necrosis, invasion of collecting system/vasculature/fat, and margin status. Molecular factors include genomic alterations and epigenetic changes leading to varying levels of RNA and protein expression. The presence or absence of these risk factors provide important information on predicted recurrence-free survival, cancer-specific survival, and overall survival. Predictive instruments incorporating various combinations of the above factors have been developed with the goal of stratifying patient and predicting outcomes to guide surveillance or consideration of adjuvant therapy in the future.