| Pathological Features of Renal Neoplasms Classified by Size and Symptomatology |
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| Friday, 09 March 2007 | ||||
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BERKELEY, CA (UroToday.com) - The increased use of radiographic imaging has resulted in the increased detection of renal masses, contributing in part to the increased overall incidence of renal cell carcinoma (RCC). Furthermore, these incidental tumors have been shown to have a better outcome, with treatment, than those that present with symptomatic tumors (less likely to be cancer and more likely to be curable with treatment). Recent reports have suggested that tumor size at presentation may be an indicator of the likelihood that a tumor is malignant. Here Schlomer and colleagues report on their 5 year experience with renal masses that presented to their institution, correlating tumor size and the presence or absence of symptoms with pathology and outcome.
During the 5 year study period, the authors treated 349 masses in 331 patients. Of these 82.8% were RCC, 16% were benign, and 1.1% were classified as "other". Mean patient age was 61 years (range 22 - 89). Incidental masses were noted in 73.9% of individuals, whereas 26.1% presented with symptoms. Radical nephrectomy was performed in 53.3% of cases, whereas nephron sparing approaches were used in 46.7%. The mean size of incidental masses was 3.7 cm, versus 6.2 cm in patients with symptoms (p less than 0.001). The percentage of malignant tumors < 2 cm was 72.1% versus 93.7% in tumors greater than 7 cm (p less than 0.05) For every increase in tumor size by 1 cm, the odds of harboring a malignancy increased by 39%. The mean size of malignant lesions was 4.6 cm, versus 2.8 cm in benign lesions (p less than 0.001). Higher grade cancers were noted in patients with symptoms (78.4%) when compared to those that were incidental (40.9%) (p=0.012). Comparison of T1 tumors that were incidental versus symptomatic revealed no difference in malignancy rates or grade of tumors detected. Comparison of T2 tumors that were incidental versus symptomatic revealed no difference in malignancy rates, but higher grade tumors were noted in those patients that were symptomatic (p=0.012). Interestingly, the average age of patients with benign tumors (64.4 years) was significantly higher than patients with malignant tumors (60.4 years) (p=0.02). This study provides further evidence that larger tumors and more symptomatic tumors are more likely to be malignant, and deserving of aggressive therapy. Smaller, asymptomatic tumors, particularly in older individuals that may not be the best surgical candidates, have a higher likelihood of being benign, and perhaps worthy of an active surveillance management strategy. Schlomer B, Figenshau RS, Yan Y, Venkatesh R, Bhayani SB J Urol 176(4): 1317-1320, 2006.
UroToday.com Renal Cancer Section
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