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A renewal of the TNM staging system for patients with renal cancer to comply with current decision-making: Proposal from the European Association of Urology guidelines panel

  • Umberto Capitanio,
  • Jens Bedke,
  • Laurence Albiges,
  • Alessandro Volpe,
  • Rachel H. Giles,
  • Milan Hora,
  • Lorenzo Marconi,
  • Tobias Klatte,
  • Yasmin Abu-Ghanem,
  • Saeed Dabestani,
  • Sergio Fernández Pello,
  • Fabian Hofmann,
  • Teele Kuusk,
  • Rana Tahbaz,
  • Thomas Powles,
  • Börje Ljungberg,
  • Axel Bex

The TNM staging system will continue to be a key backbone of risk classification for patients with RCC. However, from a clinical point of view, it appears of utmost importance to update the TNM staging categories to reflect the epochal changes that we have observed over the past five years for the management of patients with small renal masses, locally advanced disease, and—even more importantly—metastatic RCC. A more clinically-oriented TNM staging scheme would ideally allow a decrease in the current rates of overtreatment and undertreatment, especially in cases of SRM, nodal invasion, and metastatic disease. 

The EAU RCC guidelines panel would like to highlight again that TNM classification should not be considered the only criterion for clinical decisionmaking: each patient’s condition, comorbidities, and willingness remain of fundamental importance in choosing the best option for individual patients. We propose a new EAU RCC staging classification which reflects the breakthrough clinical improvements we have observed in the past decade and might be useful for driving further insights, research, and validation.