NKCA SotN 2024 Appendix and Glossary
Source: data.gov.uk (2024-09-19)

National Kidney Cancer Audit State of the Nation Report 2024. The National Kidney Cancer Audit (NKCA) aims to evaluate the patterns of care and outcomes for people with kidney cancer in England and Wales, using routinely collected data and to support services to improve their care quality.

This State of the Nation report aims to help NHS organisations to benchmark their kidney cancer care against measurable standards, to identify unwarranted variation in measures of processes and outcomes, and to describe national levels and patterns of these measures in England and Wales.

The performance indicators include people diagnosed with kidney cancer between January 2017 to December 2021 in England using the National Cancer Registration Dataset (NCRD), and January 2022 to December 2022 in Wales. It reports on eight performance indicators for England and four for Wales outlined in the NKCA Quality Improvement Plan 2024. The report also describes the national picture and variation between NHS trusts in England/Health Boards in Wales. 

For the national picture sections, we use the most recently available data in England from the Rapid Cancer Registration Dataset (RCRD) reporting on people diagnosed between 1st January 2019 and 30th September 2023, and in Wales between 1st January 2022 and 31st December 2022.

Appendix: National Kidney Cancer Audit State of the Nation Report 2024
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National Kidney Cancer Audit
State of the Nation Report 2024
Appendix and Glossary

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Contents
Acknowledgements ..................................................................................................... 3
Supplementary tables .................................................................................................. 4
Supplementary figures ................................................................................................. 8
TNM (Tumour Node Metastasis) definitions .................................................................... 9
Glossary .................................................................................................................. 10

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Acknowledgements
The National Kidney Cancer Audit (NKCA) is part of the National Cancer Audit Collaborating Centre
(NATCAN), a national centre of excellence to strengthen NHS cancer services by looking at treatments
and outcomes for people diagnosed with cancer in multiple cancer types across England and Wales.
NATCAN is commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS
England and the Welsh Government as part of the National Clinical Audit and Patient Outcomes
Programme (NCAPOP).

Clinical leadership of the National Kidney Cancer Audit is provided by representatives from the British
Association of Urological Surgeons (BAUS) and British Uro-Oncology Group (BUG). The audit is a
collaboration between the Clinical Effectiveness Unit (CEU) at the Royal College of Surgeons of England
(RCS), BAUS and BUG. We would like to thank British Association of Urological Surgeons and British Uro-
Oncology Group for their continued professional guidance and for raising awareness amongst urological
and uro-oncological colleagues.

The NKCA’s Clinical Reference Group (CRG) is formed of members representing patient groups and
professionals. We would like to thank the Chair of the group, Dr Lisa Pickering, along with CRG members
for sharing their clinical and policy expertise and experience, and for providing valuable feedback
throughout the different stages of the audit.

We would also like to thank all urologists, uro-oncologists along with their clinical and non-clinical teams
at NHS Trusts in England and Local Health Boards in Wales who collected and submitted data for the
audit. Your support is vital to enable the NKCA evaluate the care that men receive following a diagnosis
of kidney cancer in England and Wales and whether this care reflects national standards of care.

The NKCA compares NHS services in England and Wales and provides these results to underpin quality
improvement activities. We are grateful to the National Cancer Registration and Analysis Service
(NCRAS) which is part of the National Disease Registration Service, NHS England (NHSE) and the Wales
Cancer Network, Public Health Wales for supporting routine cancer data submissions from Trusts and
Local Health Boards and for supplying data for this report.

We would also like to thank all members of the newly formed NKCA Patient and Public Involvement (PPI)
Forum, Action Kidney Cancer, and Kidney Cancer UK, for working with us to ensure that the voice of
people who have had a kidney cancer diagnosis is central to the direction of the NKCA. A lay report
summarising the key results will be developed in consultation with the NKCA PPI Forum and published in
October 2024.

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Supplementary tables

Patient characteristics tables
Table A1. Patient characteristics for people newly diagnosed with kidney cancer in England over the
period of 1 January 2019 - 31 December 2021.
Data variable
England
N
%
Time period covered
1 Jan 2019 - 31 Dec 2021
No. of people with new diagnosis of kidney cancer
28,229

Age

<45
1,382
5%
45-54
3,370
12%
55-64
6,147
22%
65-74
8,238
29%
75-84
6,599
23%
>85
2,493
9%
Total
28,229
100%
Missing
0
(0%)
Gender (Self-stated gender at diagnosis)

Male
18,110
64%
Female
10,119
36%
Total
28,229
100%
Missing
0
(0%)
Performance status*

0
6,464
58%
1-2
4,048
36%
≥3
705
6%
Total
11,217
100%
Missing
17,012
(60%)
Number of co-morbidities (Charlson score)

0
14,576
52%
1
8,090
29%
≥2
5,563
20%
Total
28,229
100%
Missing
0
(0%)
Stage

I
10,713
50%
II
1,445
7%
III
4,440
21%
IV
4,851
23%
Total
21,449
100%
Missing
6,780
(24%)

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Data variable
England
N
%
Time period covered
1 Jan 2019 - 31 Dec 2021
T stage

T1
13,059
58%
T2
2,329
10%
T3
6,284
28%
T4
688
3%
Total
22,360
100%
Missing
5,869
(21%)
N stage

N0
18,232
90%
N1
1,982
10%
Total
20,214
100%
Missing
8,015
(28%)
M stage

M0
16,982
79%
M1
4,632
21%
Total
21,614
100%
Missing
6,615
(23%)
Ethnicity

Asian or Asian British
904
3%
Black, Black British, Caribbean or African
580
2%
Mixed or multiple ethnic groups
160
1%
White
24,589
92%
Other
417
2%
Total
26,650
100%
Missing
1,579
(6%)
Indices of multiple deprivation (IMD) of LSOA

1 (least deprived)
5,770
20%
2
6,004
21%
3
5,824
21%
4
5,436
19%
5 (most deprived)
5,195
18%
Total
28,229
100%
Missing
0
(0%)
LSOA, Lower Layer Super Output Areas.
*Performance status: 0 = Able carry out all normal activity without restriction; 1 = Restricted in physically strenuous activity, but
able to walk and do light work; 2 = Able to walk and capable of all self care, but unable to carry out any work. Up and about
more than 50% of waking hours; 3 = Capable of only limited self care, confined to bed or chair more than 50% of waking hours;
4 = Completely disabled. Cannot carry on any self care. Totally confined to bed or chair.

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Table A2. Patient characteristics for people newly diagnosed with kidney cancer in Wales over the
period of 1 January 2022 - 31 December 2022.

Data variable
Wales
N
%
Time period covered
1 Jan 2022 - 31 Dec 2022
No. of people with new diagnosis of kidney cancer
490

Age

<45
18
4%
45-54
44
9%
55-64
111
23%
65-74
144
29%
75-84
132
27%
>85
41
8%
Total
490
100%
Missing
0
(0%)
Sex

Male
310
65%
Female
169
35%
Total
479
100%
Missing
11
(2%)
Performance status*

0
161
47%
1-2
142
41%
≥3
41
12%
Total
344
100%
Missing
146
(30%)
Number of co-morbidities (Charlson score)

0
280
57%
1
133
27%
≥2
77
16%
Total
490
100%
Missing
0
(0%)
Stage

I
162
43%
II
41
11%
III
95
25%
IV
76
20%
Total
374
100%
Missing
116
(24%)
T stage

T1
168
46%
T2
54
15%
T3
116
32%

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Data variable
Wales
N
%
Time period covered
1 Jan 2022 - 31 Dec 2022
T4
26
7%
Total
364
100%
Missing
126
(26%)
N stage

N0
278
84%
N1
52
16%
Total
330
100%
Missing
160
(33%)
M stage

M0
247
79%
M1
67
21%
Total
314
100%
Missing
176
(36%)
Ethnicity

All other ethnic groups combined**
8
3%
White
277
97%
Total
285
100%
Missing
205
(42%)
Indices of multiple deprivation (IMD) of LSOA

1 (least deprived)
86
19%
2
86
19%
3
108
24%
4
100
22%
5 (most deprived)
74
16%
Total
454
100%
Missing
36
(7%)
LSOA, Lower Layer Super Output Areas.
*Performance status: 0 = Able carry out all normal activity without restriction; 1 = Restricted in physically strenuous activity, but
able to walk and do light work; 2 = Able to walk and capable of all self care, but unable to carry out any work. Up and about
more than 50% of waking hours; 3 = Capable of only limited self care, confined to bed or chair more than 50% of waking hours;
4 = Completely disabled. Cannot carry on any self care. Totally confined to bed or chair.
** All other ethnic groups combined includes, Asian or Asian British, Black, Black British, Caribbean or African, Mixed or
multiple ethnic groups and Other ethnicity groups. Individual ethnic groups were collapsed due to small numbers.

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Supplementary figures

Figure A1. Diagnosis by RCRD disease stage in England 2019 - 2023
Footnote: 2023 data includes patients diagnosed until 31st Oct 2023.

Figure A2. Diagnosis by disease stage in Wales in 2022

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TNM (Tumour Node Metastasis) definitions
Table A3. TNM Stage adapted from UICC TNM 8 - UICC TNM staging for kidney cancer and EAU RCC
Guidelines - TNM staging for kidney cancer

T – Primary tumour
T0
No Evidence of primary tumour
T1a
Tumour less than or equal to 4cm
T1b
Tumour more than 4cm but less than or equal to 7cm
T2a
Tumour more than 7cm but less than or equal to 10cm
T2b
Tumour more than 10cm but limited to the kidney
T3
Tumour extends into major veins or perinephric tissues but not into
ipsilateral adrenal gland and not beyond Gerota fascia
T4
Tumour invades beyond Gerota fascia (including contiguous extension
into the ipsilateral adrenal gland)
N- Regional Lymph Nodes
N0
No regional lymph node metastasis
N1
Metastasis in regional lymph node(s)
M – Distant metastasis
M0
No distant metastasis
M1
Distant metastasis

T3+ and/or 10cm+ and/or N1 M0
RCC
Tumour extends into major veins or perinephric tissues or invades
beyond Gerota fascia and/or tumour more than 10cm in size and/or
metastasis in regional lymph node(s) with no distant metastasis
T2-3NxM0 RCC
Tumour is more than 7cm in size or tumour extends into major veins or
perinephric tissues with no distant metastasis
T1b-3NxM0 RCC
Tumour is more than 4cm in size or tumour extends into major veins or
perinephric tissues with no distant metastasis
T1aN0M0 RCC
Tumour is less than or equal to 4cm in size with no regional lymph node
metastasis and no distant metastasis

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Glossary
Radical Nephrectomy
The surgical removal of an entire kidney to treat kidney cancer. The adrenal gland which is a
small triangular shaped gland located on top of each kidney is left behind if not involved with
the kidney cancer. It produces hormones to help regulate metabolism.

Partial Nephrectomy
The surgical removal of part of the kidney which contains the kidney cancer. The goal is to
remove the diseased portion while preserving as much of the healthy kidney tissue as possible.

Thermal Ablation
Thermal ablation is the used to treat small kidney cancers by using extreme heat or cold to
destroy cancer cells. Radiofrequency Ablation (RFA): Uses high-energy radio waves to generate
heat that destroys cancer cells. Microwave ablation (MWA): Uses microwave energy to
generate heat and destroy cancer cells. Cryoablation: Uses extreme cold to freeze and kill
cancer cells.

Nephron Sparing Treatment
Can be used to describe both partial nephrectomy and thermal ablation, as both involvement
treatment of the kidney cancer while preserving the healthy kidney tissue.

Renal Biopsy
A procedure where small piece of kidney tissue is removed for examination under a microscope
to determine the presence of kidney cancer and help guide treatment.

Metastatic Disease
When cancer has spread from its initial site of development in the kidney (the primary site) to
distant sites of the body (the metastatic site(s)). The diagnosis is usually made by imaging tests.

Systemic Therapy
Systemic therapy is anti-cancer drug therapy. This includes novel targeted therapies (i.e.
Pembrolizumab, Nivolumab, Ipilimumab, Cabozantinib, Axitinib, Lenvatinib) for kidney cancer.

Radiotherapy
The use of radiation to destroy cancer cells. Since cancer cells grow and divide quickly, radiation
disrupts their growth, leading to their destruction. There are different types of radiotherapy,
including stereotactic ablative radiotherapy (SABR) and external beam radiotherapy (EBRT).
SABR uses high doses of radiation delivered in fewer sessions and can be used to treat kidney
cancer in selected situations. EBRT can be used to treat kidney cancer when it has spread to
other parts of the body.

Staging/stage

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The anatomical extent of a cancer. This indicates whether a cancer is only present in the
kidney/primary site (localised disease) or whether it has spread to other areas of the body
(metastatic spread). It is usually denoted by the TNM staging process where “T” represents the
local stage, “N” the presence of lymph node involvement and “M” represents the presence of
metastatic disease.

T1 is divided into T1a and T1b depending on how big the cancer is:
• T1a means the cancer measures 4cm or less
• T1b means the cancer measures between 4cm and 7cm
T2 is divided into T2a and T2b depending on size:
• T2a means the cancer measures between 7cm and 10cm
• T2b means the cancer measures more than 10cm but completely inside the kidney
T3 is divided into T3a, T3b and T3c depending on whether the cancer has grown into
surrounding tissues or main blood vessels:
• T3a means the cancer has grown into the nearby tissues or the renal vein.
• T3b means the cancer has grown into the vena cava, but hasn't spread above the
diaphragm (sheet of muscle that separates chest and abdominal cavity, which helps us
breathe)
• T3c means the cancer has grown into the vena cava and spread above the diaphragm.
Or has grown into the wall of the vena cava.
T4 means the cancer has spread beyond the layer of tissue around the kidney (fascia). It might
have spread into the adrenal gland above the kidney.
N0 means that the nearby lymph nodes do not contain cancer cells
N1 means there are cancer cells in lymph nodes near the kidney
M0 means the cancer has not spread to other parts of the body
M1 means the cancer has spread to other parts of the body such as the lungs