Conference summary

This meeting was the first international multidisciplinary workshop on renal cell carcinoma held by the World Health Organization in collaboration with the Union Internationale Contre le Cancer (UICC), American Joint Committee on Cancer (AJCC), Mayo Clinic and Mayo Foundation, the Pacific Northwest Cancer Foundation, and other sponsoring groups. Its purpose was, in large measure, met successfully, as a result of the efforts of the distinguished faculty. We are especially grateful for the support this workshop received from the various foundation sources. Significant progress was documented for all aspects of the diagnosis and prediction of the outcome of renal cell carcinoma, but many issues remain unresolved. All workgroup reports were discussed and modified to some extent at the general session to reflect the collective understanding and concerns in each area. International agreement was reached on the histologic classification of renal cortical epithelial neoplasms. Papillary adenoma Renal oncocytoma Metanephric adenoma and adenofibroma Conventional (clear cell) renal carcinoma Papillary renal carcinoma Chromophobe renal carcinoma Collecting duct carcinoma Renal cell carcinoma, unclassified Information that is essential to patient management is contained in the report on grading. Nuclear grading is preferred, but the optimal system has not been described or tested. Grading remains subjective, but new methods, including computer-based morphometric studies, may improve objectivity. The current staging system for renal cell carcinoma has evolved and merits attention for future change. The AJCC and the UICC have published new manuals for staging in 1997, and those standards are reported herein. Issues of specimen handling by the pathologist are also discussed. Current prognostic factors for use in the evaluation of renal cell carcinoma are reviewed and prioritized on the basis of current available information. This consensus provides a basis for adoption. Use and testing in the clinic and in randomized trials are at three levels: prior to treatment, after nephrectomy, and in the presence of recurrent or metastatic cancer. There are numerous new and pending prognostic factors that merit serious consideration and examination. Such efforts should be supported for further investigation. In this report, future prognostic factors are critically evaluated, with emphasis on their practical relevance to renal cell carcinoma. This group addressed data regarding priorities for renal cell carcinoma funding, placing emphasis on clinical trials. Chemoprevention was noted to be an area of endeavor that merits attention, as does immunotherapy, gene therapy, and vaccine therapy. Molecular biology is providing a multitude of new targets for intervention, and these should be exploited in future studies. This report was meant to provide references as standards for timely and future assessments.