Growth Pattern of Clear Cell Renal Cell Carcinoma in Patients with Delayed Surgical Intervention: Fast Growth Rate Correlates with High Grade and May Result in Poor Prognosis

Abstract

Objectives. Previous studies revealed an unclear correlation between the growth rate of renal cell carcinoma (RCC) and tumor grade and did not focus on certain histological subtype. This report investigated the correlation between the growth rate and tumor grade in clear cell RCC (ccRCC). Methods. We reviewed 60 patients with 61 ccRCC confirmed by delayed surgeries after at least 12 months of active surveillance. The linear growth rate (LGR), volumetric growth rate (VGR), and volume doubling time (VDT) were calculated, and their correlations with clinicopathologic characteristics were analyzed. Results. The mean LGR, VGR, and VDT were 0.86 (range 0–4.74) cm/year, 20.96 (range 0.31–211.93) cm3/year, and 667 (range 33–3321) days, respectively. ccRCCs with high grade had greater LGR (P < 0.001) and VGR (P = 0.001) and lower VDT (P = 0.017) than ccRCCs with low grade. Grade (OR = 5.185, P = 0.004) was the only independent risk factor of LGR >0.5 cm/year, and grade (OR = 3.006, P = 0.046) and initial size (OR = 0.392, P = 0.004) were independent risk factors of VDT <1 year. Five patients developed metastasis after surgery with LGR >0.5 cm/yr altogether; of them, four had cancer-related death by the last follow-up. Conclusions. Fast growth rate of ccRCC is significantly correlated with high tumor grade and may result in poor prognosis, especially for those with LGR >0.5 cm/yr.

Natural history and growth kinetics of clear cell renal cell carcinoma in sporadic and von Hippel-Lindau disease

“…Given the fact that predictors of rapid tumor growth rate remain elusive (7), we further investigated the factors related to the growth rate. A study conducted by Kouba et al reported a faster growth rate in young patients than in old patients (17); however, our previous study (11) and this study failed to identify a correlation between age and growth rate in either group.…”

“…Natural history and growth kinetics of clear cell renal cell carcinoma in sporadic and von Hippel-Lindau disease investigated the growth kinetics of sporadic clear cell renal cell carcinoma (ccRCC) (7)(8)(9)(10)(11) and ccRCC in von Hippel-Lindau (VHL) disease (12)(13)(14)(15); however, the difference in growth kinetics between the two groups is not well understood. Hence, the aim of our study was to further evaluate and compare the growth kinetics of sporadic ccRCC with those of ccRCC in VHL disease.…”

The role of active surveillance of small renal masses

“…(17,51) A recent study also showed that a faster linear and volume growth rate and a shorter volume doubling time significantly correlates with a higher grade histology for clear cell RCCs under AS. (52) No standardized criteria to indicate delayed intervention during AS have been yet defined. However, reaching a diameter of 3-4 cm or a tumor volume doubling time <12 months under surveillance are generally used to identify renal masses at greatest risk of progression which should be conveyed to an active treatment.…”

A novel prognostic nomogram based on 5 long non‑coding RNAs in clear cell renal cell carcinoma

“…ccRCC ranks first in incidence amongst all histological types of kidney malignancies (19), and accounts for nearly 3% of all types of adult malignancies (20). Although the 5-year survival rate of patients with ccRCC at the early stage is >90%, it decreases to 10% in patients with advanced ccRCC (5), and >100,000 patients succumb to ccRCC per year worldwide (21). Therefore, it is imperative to identify tumor-specific markers for risk stratification that may be utilized for assessing the prognosis of patients, and which may facilitate the development of novel strategies for the diagnosis and therapy of ccRCC.…”