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Peer-reviewedCC BY-NC-ND 4.0Chinese Medical Journal

Reclassifying renal cell carcinoma with pathologic lymph node metastasis: An approach to refining prognostic stratification in patients with AJCC III and IV stages

  • Xu Bai1
  • Tongyu Jia2
  • Houming Zhao2
  • Honghao Xu1
  • Xiaohui Ding3
  • Yazhuo Li4
  • Lan Li5
  • Xuetao Mu6
  • Haili Liu7
  • Hongtao Zhang8
  • Mengmeng Zhang8
  • Sicheng Yi1
7 more authors
  • Huiyi Ye1
  • Xu Zhang2
  • Aitao Guo5
  • Xin Ma2
  • Haiyi Wang1
  • Xiuyuan Hao
  • Tingting Yang
8 affiliations
  1. 11 Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
  2. 23 Department of Urology, Third Medical Center, Chinese PLA General Hospital, Beijing 100039, China
  3. 34 Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
  4. 45 Department of Pathology, Fourth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
  5. 56 Department of Pathology, Third Medical Center, Chinese PLA General Hospital, Beijing 100039, China
  6. 67 Department of Radiology, Third Medical Center, Chinese PLA General Hospital, Beijing 100039, China
  7. 78 Department of Radiology, Fourth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
  8. 82 Department of Radiology, Fifth Medical Center, Chinese PLA General Hospital, Beijing 100039, China
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Abstract

Background:. Lymph node metastasis is a well-established prognostic factor in renal cell carcinoma (RCC); however, the prognosis varies among patients with nodal metastases. Subclassification by T category may improve the prognostic stratification. Methods:. This study aimed to refine the prognostic stratification of advanced RCC by analyzing the overall survival and cancer-specific survival of patients classified as pT1–3N1M0. We retrospectively analyzed data from 364 patients with American Joint Committee on Cancer (AJCC) stage III and IV RCC who underwent nephrectomy with lymphadenectomy at multiple centers between 2010 and 2023. Five-year survival rates were estimated using Kaplan–Meier analysis, and the concordance index (C-index) was used to assess the stratification ability of the different staging systems. Multivariable analyses were conducted to adjust for potential confounders. Additionally, 194 and 1513 patients from The Cancer Genome Atlas and Surveillance, Epidemiology, and End Results databases were used to validate the prognostic values. Results:. Patients with pT1–2N1M0 had significantly better 5-year survival rates than those with pT3N1M0 (overall survival: 62.4% vs. 31.5%, P = 0.003; cancer-specific survival: 62.4% vs. 38.5%, P = 0.008). Reclassifying pT3N1M0 from AJCC stage III to IV improved prognostic discrimination, as reflected by higher C-index values compared to the AJCC staging (8th edition) (ΔC-index: 0.03–0.10, all P values <0.05). The modified staging system demonstrated comparable performance to the previous system while avoiding the over-staging of patients with pT1–2N1M0 (ΔC-index: 0–0.04, most P values >0.05), as confirmed across local and external cohorts. These findings were supported by the multivariable analyses. Conclusion:. Reclassifying pT3N1M0 as stage IV improves prognostic stratification in RCC.

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Cite

BibTeXRIS
BibTeX
@article{bai2026reclassifying,
  title = {{Reclassifying renal cell carcinoma with pathologic lymph node metastasis: An approach to refining prognostic stratification in patients with AJCC III and IV stages}},
  author = {Xu Bai and Tongyu Jia and Houming Zhao and Honghao Xu and Xiaohui Ding and Yazhuo Li and Lan Li and Xuetao Mu and Haili Liu and Hongtao Zhang and Mengmeng Zhang and Sicheng Yi and Huiyi Ye and Xu Zhang and Aitao Guo and Xin Ma and Haiyi Wang and Xiuyuan Hao and Tingting Yang},
  journal = {Chinese Medical Journal},
  year = {2026},
  month = jun,
  doi = {10.1097/cm9.0000000000004186},
  url = {https://doi.org/10.1097/cm9.0000000000004186},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Reclassifying renal cell carcinoma with pathologic lymph node metastasis: An approach to refining prognostic stratification in patients with AJCC III and IV stages
AU  - Xu Bai
AU  - Tongyu Jia
AU  - Houming Zhao
AU  - Honghao Xu
AU  - Xiaohui Ding
AU  - Yazhuo Li
AU  - Lan Li
AU  - Xuetao Mu
AU  - Haili Liu
AU  - Hongtao Zhang
AU  - Mengmeng Zhang
AU  - Sicheng Yi
AU  - Huiyi Ye
AU  - Xu Zhang
AU  - Aitao Guo
AU  - Xin Ma
AU  - Haiyi Wang
AU  - Xiuyuan Hao
AU  - Tingting Yang
PY  - 2026
DA  - 2026/06/26
JO  - Chinese Medical Journal
DO  - 10.1097/cm9.0000000000004186
UR  - https://doi.org/10.1097/cm9.0000000000004186
AB  - Background:. Lymph node metastasis is a well-established prognostic factor in renal cell carcinoma (RCC); however, the prognosis varies among patients with nodal metastases. Subclassification by T category may improve the prognostic stratification. Methods:. This study aimed to refine the prognostic stratification of advanced RCC by analyzing the overall survival and cancer-specific survival of patients classified as pT1–3N1M0. We retrospectively analyzed data from 364 patients with American Joint Committee on Cancer (AJCC) stage III and IV RCC who underwent nephrectomy with lymphadenectomy at multiple centers between 2010 and 2023. Five-year survival rates were estimated using Kaplan–Meier analysis, and the concordance index (C-index) was used to assess the stratification ability of the different staging systems. Multivariable analyses were conducted to adjust for potential confounders. Additionally, 194 and 1513 patients from The Cancer Genome Atlas and Surveillance, Epidemiology, and End Results databases were used to validate the prognostic values. Results:. Patients with pT1–2N1M0 had significantly better 5-year survival rates than those with pT3N1M0 (overall survival: 62.4% vs. 31.5%, P = 0.003; cancer-specific survival: 62.4% vs. 38.5%, P = 0.008). Reclassifying pT3N1M0 from AJCC stage III to IV improved prognostic discrimination, as reflected by higher C-index values compared to the AJCC staging (8th edition) (ΔC-index: 0.03–0.10, all P values <0.05). The modified staging system demonstrated comparable performance to the previous system while avoiding the over-staging of patients with pT1–2N1M0 (ΔC-index: 0–0.04, most P values >0.05), as confirmed across local and external cohorts. These findings were supported by the multivariable analyses. Conclusion:. Reclassifying pT3N1M0 as stage IV improves prognostic stratification in RCC.
SN  - 0366-6999
SN  - 2542-5641
ER  -