Risk of Metastatic Renal Cell Carcinoma According to Tumor Size

Thompson, R. Houston; Hill, James L.; Babayev, Yuriy; Cronin, Angel M.; Kaag, Matt; Kundu, Shilajit; Bernstein, Melanie; Coleman, Jonathan; Dalbagni, Guido; Touijer, Karim; Russo, Paul

doi:10.1016/s0022-5347(09)60610-8

Cited by 36 publications

(47 citation statements)

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“…In contrast to these studies, in the present study there was not a single synchronous metastasis at presentation in 212 tumours < 2 cm, which was also the case for the institutional observation from Memorial Sloan-Kettering and Fox Chase Cancer Centers [15,20]. We observed only 1 synchronous metastasis at presentation in 417 tumours of 2-2.9 cm.…”

Section: Discussioncontrasting

confidence: 70%

“…Observations from Memorial Sloan-Kettering had remarkably similar results to those presented in the present study, with only one patient having M1 disease with a primary tumour < 3 cm. [20] As single, tertiary institution studies, both the present study and the Memorial Sloan-Kettering study were able to ensure follow-up and review all metastatic cases radiographically and/or pathologically for confirmation. Considerable biases are alleviated in this way and probably account for the higher percentage of M1 at presentation of SRMs in other studies.…”

Section: Discussionmentioning

confidence: 92%

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Metastatic potential of a renal mass according to original tumour size at presentation

Umbreit¹,

Shimko²,

Childs³

et al. 2011

BJU International

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RESULTS• Of the 2651 patients studied, 182 (6.9%) presented with M1 RCC. Tumour size was significantly greater in patients with M1 RCC than in patients with M0 RCC (a median size of 10 vs 4.5 cm; P < 0.001). Only 1 of the 629 patients (0.2%) with a tumour < 3 cm had M1 RCC and that tumour was 2.5 cm. The risk of M1 RCC increased from 1.1% for patients with tumours 3-3.9 cm to 16.5% for patients with tumours ≥ 7 cm.• Of the 2124 patients with M0 RCC, 430 developed distant metastases at a median (range) of 1.4 (0.1-16.2) years after surgery. Only 9 of the 498 patients (1.8%) with a tumour < 3 cm developed distant metastases after surgery.• Each 1-cm increase in tumour size increased the risk of death from RCC by 20% [hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.18-1.22; P < 0.001] and death from any cause by 10% (HR 1.10; 95% CI 1.09-1.12; P < 0.001).• For the 1346 patients who were still alive at last follow-up, the median (range) duration of follow-up was 6.9 (0.1-19.7) years. CONCLUSIONS• Tumour size is significantly associated with metastases in patients with renal masses.• Patients with tumours < 3 cm have a low risk of synchronous metastatic disease. KEYWORDSkidney neoplasms, renal cell carcinoma, nephrectomy, recurrence, neoplasm staging, neoplasm metastasis Study Type -Prognosis (case series) Level of Evidence 4 OBJECTIVE• To determine the metastatic potential of renal masses based on original tumour size. MATERIALS AND METHODS• We identified 2651 patients who had undergone surgical resection for a unilateral, sporadic renal tumour between 1990 and 2006.• Associations of tumour size with synchronous metastasis at presentation [M1 renal cell carcinoma (RCC)] and development of metastases, death from RCC, and death from any cause after surgery were evaluated using logistic and Cox proportional hazards regression.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 92%

Metastatic potential of a renal mass according to original tumour size at presentation

Umbreit¹,

Shimko²,

Childs³

et al. 2011

BJU International

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“…The greatest increase in detection has been seen in small renal masses (clinical stage T1a, ≤4 cm), of which >50% are incidentally discovered . Clinical stage T1a small renal masses are biologically heterogeneous, with most being low‐grade, indolent cancers and up to 20–30% being benign masses . Traditionally, patients with stage I renal masses have undergone surgery, most commonly radical or partial nephrectomy; however, the risk of comorbidities and overtreatment may outweigh the benefits of these surgical interventions, especially in those with reduced life expectancy.…”

Section: Introductionmentioning

confidence: 99%

Multiple growth periods predict unfavourable pathology in patients with small renal masses

et al. 2017

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“…It has been previously shown, in both single institution and population‐based analyses, that a small portion of kidney tumours <3 cm are metastatic [3–5]. Estimates of metastases in SRMs have varied greatly, from only one in 720 (0.1%) patients in a study by Thompson et al .…”

Section: Introductionmentioning

confidence: 99%

Predictors of locally advanced and metastatic disease in patients with small renal masses

et al. 2011

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Study Type – Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? There is a small cohort of patients who have small renal masses with metastatic potential, yet risk factors for having this more aggressive disease are largely unknown. In a large sampling of the US population, older patients and men were more likely to have small renal masses at an advanced stage. OBJECTIVES To assess the prevalence metastatic and locally advanced renal cell carcinoma (RCC) in the US population with small renal masses (SRMs). To determine what patient and tumour characteristics predict having more advanced SRMs. PATIENTS AND METHODS Using the Surveillance, Epidemiology and End Results (SEER) registry, we identified 14 962 patients who were diagnosed between 1988 and 2007 with RCC ≤3 cm in size. Patients were separated by stage into those with metastatic, locally advanced and localized disease. Differences in baseline characteristics between patients in these three groups were assessed. After controlling for age, sex, grade, tumour size and year of surgery, a logistic regression analysis was performed to determine the likelihood of having non‐localized disease. RESULTS In the SEER cohort, 13 574 (90.7%) patients with RCC ≤3 cm in size were diagnosed with localized disease, 938 (6.3%) patients had invasion beyond the kidney into regional lymph nodes or nearby organs, and 450 (3.0%) patients had distant metastasis. Patients with metastasis were older (65.9 years) compared to those with localized disease (59.5 years) (P < 0.001). Independent preoperative predictors of having more aggressive disease at diagnosis (locally advanced/metastatic) included older age, particularly age >70 years (odds ratio, OR, 2.42; 95% confidence interval, CI, 2.03–2.88), male sex (OR, 1.50; 95% CI, 1.33–1.70) and tumour size >2.5 (OR, 1.41; 95% CI, 1.25–1.58). CONCLUSIONS A small subset (3%) of patients in the USA with RCC ≤3 cm in size have distant metastasis. Older patients, men and those with tumours 2.5–3.0 cm in size have a greater probability of presenting with non‐localized disease . Clinicians should be aware that there is a risk of metastases in patients with SRMs and also familiarize themselves with the characteristics associated with advanced disease.

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Risk of Metastatic Renal Cell Carcinoma According to Tumor Size

Cited by 36 publications

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Metastatic potential of a renal mass according to original tumour size at presentation

Metastatic potential of a renal mass according to original tumour size at presentation

Multiple growth periods predict unfavourable pathology in patients with small renal masses

Predictors of locally advanced and metastatic disease in patients with small renal masses

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