Purpose-Recent evidence suggests significantly discordant findings regarding tumor size and the risk of metastases in renal cell carcinoma (RCC). Herein, we present our experience with RCC and evaluate the association between tumor size and risk of metastases in a large cohort of patients.Methods-Using our prospectively maintained nephrectomy database, we identified 2,691 patients treated surgically for a sporadic renal cortical tumor between 1989 and 2008. Associations between tumor size and synchronous metastases at presentation (M1 RCC) were evaluated with logistic regression models while metastases-free survival following surgery was estimated using the KaplanMeier method for 2,367 patients who did not present with M1 RCC and who were followed postoperatively.Results-Among the 2,691 patients, 162 presented with metastatic RCC. Only 1 of 781 patients with a tumor <3cm had M1 RCC at presentation and tumor size was significantly associated with metastases at presentation (odds ratio 1.25 for each 1cm increase, p<0.001). Among the 2,367 patients who did not present with metastases, 171 developed metastatic disease during a median follow-up of 2.8 years. In this group, only 1 of the 720 patients with RCC <3cm developed a de novo metastases during follow-up. Metastases-free survival was significantly associated with tumor size (hazard ratio 1.24 for each 1cm increase, p<0.001).Conclusion-In our experience, tumor size is significantly associated with synchronous metastases and asynchronous metastases following nephrectomy. Our results suggest that risk of metastatic disease for patients with tumors <3cm is negligible.

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