However, even small renal tumors can present with symptoms, both local and systemic, and symptomatic presentation has been shown to be associated with a worse prognosis. Here, Kawata and colleagues examine local tumor findings and correlate their presence with the presence of symptoms as stratified by Patard's criteria, where S1 refers to no symptoms present, S2 refers to local tumor symptoms only, and S3 refers to the presence of systemic symptoms.

The authors examined the tumors of 232 patients with localized RCC, looking at both pathologic findings as well as performing immunohistochemistry for matrix metalloproteinase (MMP) 1, MMP 2, MMP 9, tissue inhibitor of metalloproteinase (TIMP) 1, and TIMP 2. Median follow-up in the study was 44 months and all patients were treated with radical nephrectomy. The authors again demonstrated that the presence of symptoms was associated with a worse outcome, where the 5 year cancer specific survival (CSS) for patients classified as S1 was 88.7%, for S2 74.7%, and for S3 67.6% (p=0.0015). The presence of symptoms was associated with a worse CSS and a higher risk of disease recurrence. The authors then examined local tumor findings and found that tumor diameter ? 4cm (p=0.007) and the presence of venous invasion (p=0.0004) significantly increased the likelihood of having local tumor symptoms (S2) in multivariate analysis. The same analysis also demonstrated that the over expression of MMP 9 (p=0.001) was the only factor that predicted for the presence of systemic symptoms (S3).

In this study, the authors correlate the presence of local and systemic symptoms, which portend a worse prognosis in patients, with local tumor findings that suggest a more aggressive phenotype. Further research is needed to determine the exact etiology of symptoms in a given tumor, which may provide clues as to potential pathways of therapeutic intervention that may improve outcomes in patients.

Kawata N, Nagane Y, Igarashi T, Hirakata H, Ichinose T, Hachiya T, Takimoto Y, Takahashi S

Urology: 68(3): 523-527 September 2006

UroToday.com Renal Cancer Section

UroToday.com Articles on MMP-9

Written by Christopher G. Wood, MD, a Contributing Editor with UroToday.

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