Synchronous Metastasis Rates in T1 Renal Cell Carcinoma: A Surveillance, Epidemiology, and End Results Database-based Study.

Synchronous metastasis (SM) rates in T1 renal cell carcinoma (RCC) patients relied on historical cohorts and may not take into account the favorable stage migration toward lower tumor size (TS) that occurred in more recent years.

To investigate SM rates in T1 RCC patients according to histological subtype (HS), tumor grade (TG), and TS.

Partial nephrectomy, radical nephrectomy, focal ablation, and non-interventional management.

Within the Surveillance, Epidemiology, and End Results database (2004-2015), 60 640 stage T1 patients were identified. SM rates were tabulated and tested in multivariable logistic regression models.

According to HS, average SM rates were 0%, 0.5%, 1.1%, 1.4%, 3.7%, 21.5%, and 36.2% for multilocular cystic, chromophobe, papillary, clear cell TG 1-2, clear cell TG 3-4, collecting duct, and sarcomatoid RCC, respectively. In a multivariate logistic regression model, age, TS, HS, and TG were independent predictors of SM. Bone only was the commonest metastatic site (41.0%), followed by lung only (24.5%), liver only (3.6%), and brain only (3.8%). Of all SM patients, 72.8% harbored a single metastatic site. The major limitations of this study are lack of recurrence and metastatic progression data.

Within T1 RCC, it was possible to identify five metastatic risk categories according to SM rates: (1) multilocular cystic RCC (0%), (2) chromophobe RCC (0-2.0%), (3) clear cell TG 1-2 and papillary RCC, (4) clear cell TG 3-4 RCC (1.2-8.9%), and (5) sarcomatoid and collecting duct RCC (7.0-49.1%). The most frequent metastatic location is bone only, followed by lung only, and virtually all SMs are solitary.

Metastatic rate varies in T1 stage renal cell carcinoma patients according to tumor size, histology, and tumor grade.

European urology focus. 2020 Mar 10 [Epub ahead of print]

Angela Pecoraro, Carlotta Palumbo, Sophie Knipper, Francesco A Mistretta, Giuseppe Rosiello, Zhe Tian, Pierre-Antoine St-Hilaire, Shahrokh F Shariat, Fred Saad, Luke Lavallée, Alberto Briganti, Anil Kapoor, Cristian Fiori, Francesco Porpiglia, Pierre I Karakiewicz

Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy. Electronic address: ., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany e Department of Urology, European Institute of Oncology, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada., Department of Urology, Medical University of Vienna, Vienna, Austria., Division of Urology, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada., Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Division of Urology, McMaster University, Hamilton, Ontario, Canada., Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.