To evaluate the outcomes of surgical intervention and active surveillance in patients diagnosed with cystic renal cell carcinoma at our hypothesized radiologic cutoff of >50% cystic.
We identified all patients with a pathologically confirmed cystic renal mass that fit our criteria from 2000 to 2015 (n=430). Patients with lack of CT imaging, tumors <50% cystic on imaging, multifocal tumors and prior renal cell carcinoma were excluded (n=292). Patients were stratified into benign or malignant subgroups, and radiologic, clinicopathologic and oncologic features were obtained. Univariate and multivariate associations between clinicoradiologic parameters in each group were analyzed. A separate cohort of patients managed by active surveillance for cystic renal cell carcinoma was similarly reviewed.
Of the 138 cases of cystic renal cell carcinoma cases identified, 102 (73.9%) were renal cell carcinoma and 36 (26.1%) benign masses. Most tumors were Fuhrman grade 1-2 (77.5%), ≤pT2 stage (83.4%) and clear cell histology (65.9%). On univariate analysis, male gender, a solid component and increasing Bosniak classification were significant for malignancy. In a separate cohort, we identified 38 patients on active surveillance. Growth rate was found to be 1.0 mm/year overall and 2.3 mm/year for the solid component. After a median follow-up of >4 years for all cohorts, there was no evidence of recurrence or metastasis from cystic renal cell carcinoma.
Patients with unifocal cystic renal cell carcinoma evaluated using a standardized radiologic threshold of >50% cystic have an excellent prognosis on both active surveillance and following surgical resection.
The Journal of urology. 2018 Feb 26 [Epub ahead of print]
Mahyar Kashan, Mazyar Ghanaat, Andreas M Hötker, Cihan Duzgol, Alejandro Sanchez, Renzo G DiNatale, Kyle A Blum, Maria Becerra, Brandon J Manley, Jozefina Casuscelli, Michael Chiok, Jonathan A Coleman, Paul Russo, Satish K Tickoo, Oguz Akin, A Ari Hakimi
Department of Surgery-Urology Service., Department of Radiology., Department of Surgery-Urology Service; Department of Urology, Miller School of Medicine University of Miami, Miami, FL., Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Urology, Ludwig-Maximilians University, Munich, Germany., Department of Pathology., Department of Surgery-Urology Service. Electronic address: .