Preoperative decision making for renal cell carcinoma: Cystic morphology in cross-sectional imaging might predict lower malignant potential

Huber, Johannes; Winkler, Alexandra; Jakobi, Hildegard; Brückner, Thomas; Roth, Wilfried; Hallscheidt, Peter; Daneshvar, Keivan; Hohenfellner, Markus; Pahernik, Sascha

doi:10.1016/j.urolonc.2013.02.016

Cited by 24 publications

(20 citation statements)

References 23 publications

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“…This is perhaps because these tumors belong to the distinct subgroup of multilocular cystic ccRCC, a rare, low-grade tumor that is known to have a favorable prognosis [16, 17] and that has been shown to have a distinct genomic makeup. Tumors in this subgroup lack mutations in SETD2 , KDM5C , and BAP1 [8], which are known to be negative prognostic factors when found in solid tumors [18, 19].…”

Section: Discussionmentioning

confidence: 99%

Clear Cell Renal Cell Carcinoma: Associations Between CT Features and Patient Survival

Hötker

Karlo

Zheng

et al. 2016

American Journal of Roentgenology

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OBJECTIVE The objective of this study was to investigate associations between CT features and survival in patients with clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS The study included 763 patients with histopathologically confirmed ccRCC who underwent preoperative contrast-enhanced CT between 1999 and 2011. Imaging features, both qualitative (cystic tumor, necrosis, tumor contact with renal sinus, renal vein invasion, peritumoral stranding, and peritumoral neovascularity) and quantitative (maximal tumor diameter and distance from the tumor to the renal sinus), were evaluated. Univariate and multivariable Cox regressions were used to assess associations of imaging features with disease-specific survival (DSS) and disease-specific progression-free survival (PFS). RESULTS Greater tumor size and the presence of renal vein invasion on CT were associated with decreased DSS and disease-specific PFS (p < 0.05), and the presence of extensive necrosis (more than two-thirds of the tumor volume) was associated with decreased disease-specific PFS (p < 0.05); this association remained statistically significant when we controlled for pathologic tumor stage. In contrast, no disease-specific death or progression was seen in patients with purely cystic tumors. Greater distance between the tumor and the renal sinus was not statistically significantly associated with longer survival. CONCLUSION In patients with ccRCC, observation of extensive necrosis on CT was statistically significantly associated with decreased disease-specific PFS, whereas greater tumor size and the presence of renal vein invasion on CT were statistically significantly associated with decreased DSS and disease-specific PFS. No disease progression was observed in tumors with a cystic appearance. Therefore, selected CT features could potentially aid in risk assessment for and counseling of patients with ccRCC and could provide prognostic information beyond the established tumor staging system.

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Section: Discussionmentioning

confidence: 99%

Clear Cell Renal Cell Carcinoma: Associations Between CT Features and Patient Survival

Hötker

Karlo

Zheng

et al. 2016

American Journal of Roentgenology

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“…Another study demonstrated that overall and cancer-specific survival was better among cystic RCCs compared with solid RCCs (37). Of 62 patients with 69 Bosniak category IIF masses and 131 patients with 144 Bosniak category III masses, although many were not resected or proven malignant (the malignancy rate of resected Bosniak category IIF lesions was 25%, and that for Bosniak category III lesions was 54%), no patients that were followed up for at least 1 year developed locally recurrent or metastatic disease (38).…”

Section: Many Small Rccs Are Indolentmentioning

confidence: 99%

Incompletely Characterized Incidental Renal Masses: Emerging Data Support Conservative Management

Silverman¹,

Israel²,

Trinh³

2015

Radiology

102

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With imaging, most incidental renal masses can be diagnosed promptly and with confidence as being either benign or malignant. For those that cannot, management recommendations can be devised on the basis of a thorough evaluation of imaging features. However, most renal masses are either too small to characterize completely or are detected initially in imaging examinations that are not designed for full evaluation of them. These masses constitute a group of masses that are considered incompletely characterized. On the basis of current published guidelines, many masses warrant additional imaging. However, while the diagnosis of renal cancer at a curable stage remains the first priority, there is the additional need to reduce unnecessary healthcare costs and radiation exposure. As such, emerging data now support foregoing additional imaging for many incompletely characterized renal masses. These data include the low risk of progression to metastases or death for small renal masses that have undergone active surveillance (including biopsy-proven cancers) and a better understanding of how specific imaging features can be used to diagnose their origins. These developments support (a) avoidance of imaging entirely for those incompletely characterized renal masses that are highly likely to be benign cysts and (b) delay of further imaging of small solid masses in selected patients. Although more evidence-based data are needed and comprehensive management algorithms have yet to be defined, these recommendations are medically appropriate and practical, while limiting the imaging of many incompletely characterized incidental renal masses.

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“…However, tumor's growth pattern (cystic vs. solid) has not been included yet. Huber et al [25] reported the first study to show that cystic morphology in crosssectional imaging might predict RCC with a lower malignant potential. Among the histopathologically confirmed cystic pRCC tumors in our sample, low stage did not prevail (40.0% of cases ≤ pT1b) and low grade tumors were clearly dominant only in pRCC1 histology.…”

Section: Discussionmentioning

confidence: 99%

Cystic Appearance on Imaging Methods (Bosniak III-IV) in Histologically Confirmed Papillary Renal Cell Carcinoma is Mainly Characteristic of Papillary Renal Cell Carcinoma Type 1 and Might Predict a Relatively Indolent Behavior of Papillary Renal Cell Carcinoma

et al. 2018

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Aim: The aim of this study was to determine the proportion of cystic tumors according to preoperative CT (Bosniak III, IV) among surgically treated patients with histologically confirmed papillary renal cell carcinoma (pRCC) and to assess progression rates among patients with and without cystic appearance on imaging. Methods: A total of 138 patients with pRCC histology surgically treated in the period of January 2007–March 2017 were included. Clinical and radiological characteristics, type of surgery, histopathology results, and follow-up data were recorded and statistically evaluated. Results: Forty-one cases (29.7%) of cystic lesions (10× BIIF, 14× BIII, 17× BIV) were detected by CT. Patients with pRCC1 significantly more frequently presented with cystic appearance on CT (33/78; 42.3%) in comparison to other papillary types (8/60; 13.3%; p = 0.0002). During a median follow-up time of 49.4 months, only 2 patients with cystic lesions progressed after surgery. Conclusions: Cystic appearance on imaging methods is mainly a characteristic of pRCC1 (42.3%). Cystic morphology on imaging might predict a relatively indolent behavior of all pRCC types. Preoperative scoring systems including tumor growth patterns (cystic vs. solid) are needed for further classification.

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Preoperative decision making for renal cell carcinoma: Cystic morphology in cross-sectional imaging might predict lower malignant potential

Cited by 24 publications

References 23 publications

Clear Cell Renal Cell Carcinoma: Associations Between CT Features and Patient Survival

Clear Cell Renal Cell Carcinoma: Associations Between CT Features and Patient Survival

Incompletely Characterized Incidental Renal Masses: Emerging Data Support Conservative Management

Cystic Appearance on Imaging Methods (Bosniak III-IV) in Histologically Confirmed Papillary Renal Cell Carcinoma is Mainly Characteristic of Papillary Renal Cell Carcinoma Type 1 and Might Predict a Relatively Indolent Behavior of Papillary Renal Cell Carcinoma

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