Renal cell carcinoma: The influence of new diagnostic imaging techniques on the size and stage of tumors diagnosed over the past 26 years

Abstract

We have analyzed data collected over a 26-year period for influences of new diagnostic imaging techniques (ultrasound, computed tomography, and magnetic resonance imaging) on the size, stage, and other parameters of renal cell carcinomas at the time of first diagnosis. We reviewed retrospectively the records of 203 patients who underwent operations at our institutions from 1973 to 1999. All the patients suffered from renal cell carcinoma. With this study we attempted to answer four questions regarding changes over this time span: (1) have new imaging techniques lead to a reduction in the median diameter of the tumor upon first diagnosis, (2) has the tumor stage decreased due to earlier diagnosis, (3) is there any correlation between tumor size and tumor stage, and (4) are the patient's early diagnoses at a younger age? Other parameters such as infiltration of the renal pelvis and the cell type were also examined. The tumor size and stage at the time of diagnosis and treatment are positively correlated, and both decrease significantly over the time span examined. There is also a strong association between tumor size and infiltration of the renal pelvis. The median age of the patients did not significantly change over time. The wider use of improved imaging techniques has significantly changed the clinical appearance of the renal cell carcinoma. The question is whether these techniques have also affected the prognosis of the disease.

Development of renal cell carcinoma (RCC) diagnostics and impact on prognosis

“…In most studies, new imaging methods have changed the presentation of RCC. Between 1973 and 1999 the proportion of patients with tumours of >10 cm decreased from 55% to 26% whereas those with tumours of <5 cm increased from 0% to 29% . Likewise, the proportion of small tumours increased from 10.2% to 62.7% between 1981 and 2006 .…”

Clinical symptoms related to renal cell carcinoma are independent prognostic factors for intraoperative complications and overall survival

“…Due to the widespread utilization of imaging devices, more and more incidental tumors are discovered and, therefore, we detect the classical symptom triad very rarely: hematuria, palpable abdominal mass, and pain [4]. However, this could not be the primary cause of the increase in occurrence since the number of advanced cases has not changed [5].…”

Role of preoperative MR volumetry in patients with renal cell carcinoma for prediction of postoperative renal function after radical nephrectomy and nephron sparing surgery

“…Its incidence has constantly increased over the last decades and currently 150.000 new cases are diagnosed every year ( 2 ). Once characterized by the classical triad of abdominal mass, flank pain and hematuria, the majority of cases are now diagnosed incidentally, these incidental masses are usually smaller compared to the historically large tumours ( 3 ). The surgical approach is directed towards removing the tumour in such a way that the maximum possible mass of the nephrons is salvaged.…”