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Evolving Principles of Surgical Management and Prognostic Factors for Outcome in Renal Cell Carcinoma

John S. Lam, Alberto Breda, Arie S. Belldegrun, Robert A. Figlin

From the Departments of Urology and Medical Oncology, University of California Los Angeles Kidney Cancer Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA

Address reprint requests to Arie S. Belldegrun, MD, University of California Los Angeles School of Medicine, Department of Urology, 10833 Le Conte Ave, 66-118 CHS/Box 051738, Los Angeles, CA; e-mail: abelldegrun{at}mednet.ucla.edu

The generally accepted principles for the surgical management of renal cell carcinoma (RCC) were first described more than 30 years ago. Since then, much has changed in the understanding of the basic biology and genetics of kidney cancer. Improvements in cross-sectional imaging has allowed for more accurate preoperative clinical staging of renal tumors, and the necessity of completing all the components of the radical nephrectomy have been questioned. Surgical techniques have also evolved, and technology has advanced to make possible new methods of managing renal tumors. The TNM staging system is currently the most extensively used system to provide prognostic information for RCC. However, data published in the last few years has led to significant controversies as to whether further revisions are needed and whether improvements can be made with the introduction of new, more accurate and predictive prognostic factors. Furthermore, the recent discovery of molecular tumor markers are expected to revolutionize the staging of RCC and lead to the development of new therapies based on molecular targeting. This review will examine the evolving principles in the surgical management of RCC as well as provide an update on current staging modalities and prognostic factors.

A.S.B. and R.A.F. share senior authorship of this article.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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