Metastatic Renal Cell Carcinoma Risk According to Tumor Size

Abstract

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.

Active surveillance of renal masses: an analysis of growth kinetics and clinical outcomes stratified by radiological characteristics at diagnosis

“…As such, understanding the average growth rate of AMLs is useful for patient counseling. Furthermore, the epithelioid variant of AMLs can behave aggressively, further illustrating the importance of monitoring these lesions (11).…”

Retrograde venous invasion in renal cell carcinoma: a complication of sinus vein and main renal vein invasion

“…The worsening prognosis documented with increasing tumor size may partially reflect the poor prognosis of tumors with intravenous invasion. [13][14][15][16][17][18] In summary, we describe the gross and microscopical features of retrograde venous invasion by renal cell carcinoma, an invasive process that may be under-recognized. Retrograde venous invasion is most common in clear-cell renal cell carcinoma, but should be considered in any tumor type when the main renal vein is involved.…”

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

“…The impact of this may be minimal, given that the rates of patients initially presenting with metastatic disease and undergoing surgery is low (6%) during the analyzed time period and has demonstrated a steady decline over the years in based on North American population studies. 16,155 Regardless, patients initially presenting with T1a (≤4cm) tumours represent an important subpopulation in which it is considered a standard of care to perform PN rather than RN. 43 The major limitation of our pathologic data is the inability to isolate this population.…”