Small Renal Masses in Latin-American Population: Characteristics and Prognostic Factors for Survival, Recurrence and Metastasis – a Multi-Institutional Study from LARCG Database - Beyond the Abstract 

Renal Cell Carcinoma (RCC) in Latin America has been ranked by age-standardized incidence since the 6th (Chile) to the 20th (El Salvador) position in males, and since the 11th (Chile) to above the 20th (Bolivia and El Salvador) position in females.1 Worldwide estimated incidence and mortality of kidney cancer according to GLOBOCAN in 2018 surpassed more than 400,000 cases, and more than 170,000 deaths, respectively.2 Despite that, official government data in Latin America are scarce. Particularly in Brazil, RCC information is not even stated on the website and annual reports of the Brazilian National Cancer Institute until this date.3

Intending to enhance regional data and to promote research and education about RCC around the world, the Latin American Renal Cancer Group, LARCG, was initially conceived in 2013 by Stênio C. Zequi, MD, PhD, (São Paulo, Brazil) and by Diego Abreu, MD (Montevideo, Uruguay). Nowadays, this group aggregates 44 institutions in several countries (Argentina, Bolivia, Brazil, Chile, Mexico, Peru, and Spain), besides North American collaborators (Figure 1).

MembrosLARCG_BTA.png
Source: Sociedade Brasileira de Urologia. [BODAU – Boletim da Urologia]. 2015, 2nd edition.

From this initiative, a database with more than 6,000 patients was created. This was a huge effort that allowed us the publication of several studies dealing with non-metastatic RCC,4 surgical outcomes in the very elderly population (≥ 75 years),5 specific prognostic value of perirenal fat invasion,6 besides of expert panel recommendations in association with LACOG (Latin American Cooperative Oncology Group) about surgical treatment and management of the advanced RCC.7,8

In the current study, we were able to report more than 1,500 cases of small renal masses (SRM) in our cohort over a period of almost 40 years. Similarly to other published series, we noted the rise of partial nephrectomies, instead of radical nephrectomies for SRM. Over the past decade, 75% of SRM underwent nephron-sparing surgery. The whole series showed around 50% of minimally invasive surgeries (laparoscopic or robot-assisted) for these cases. The preference for partial nephrectomy benefited mainly the elderly patients (≥ 65 years) with a significant increase of the 10-year overall survival from 54.5% to 83.5%, compared to the elderly who underwent radical nephrectomy. Finally, we reported a multivariable logistic regression model evidencing that bilateral tumors, extracapsular extension, and ASA classification ≥ 3 were prognostic factors for local recurrence in our series.

Written by: Thiago C. Mourão, MD, Hospital Paulistano and Instituto de Urologia, Oncologia e Cirugia Robótica, São Paulo, Brazil, and Stênio de Cássio Zequi, MD, MsC, PhD, A.C. Camargo Cancer Center, São Paulo, Brazil 

References: 

  1. Sierra MS, Soerjomataram I, Antoni S, Laversanne M. Cancer patterns and trends in Central and South America. Cancer Epidemiology. 2016;44S:S23-S42.
  2. Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2018;00:1-13.
  3. Ministério da Saúde. Instituto Nacional do Câncer. [Tipos de Câncer]. Retrieved from https://www.inca.gov.br/tipos-de-cancer. Last updated on Sep 12th, 2019. Accessed on Jul 9th, 2020.
  4. Zequi SC, Mourão TC, Oliveira MM, et al. Predictors of Survival Outcomes in Non-Metastatic Renal Cell Carcinoma in Latin America and Spain: A Multicentric Analysis. Kidney Cancer. 2019;3:253-261.
  5. Garza-Gangemi AM, Castillejos-Molina RA, Gueglio G, et al. Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group. Rev Invest Clin. 2020; 10.24875/RIC.20000018.
  6. Marchiñena PG, Tobia I, Abreu-Clavijo D, et al. Prognostic value of perirenal and/or sinus fat infiltration in patients with pT3a renal cell carcinoma: A multicentre cohort study. LARCG Group. Actas Urol Esp. 2019;43(9):495-502.
  7. Zequi SC, Costa WH, Korkes F, et al. Renal Cell Cancer Treatment: An Expert Panel Recommendation From the Latin American Cooperative Group-Genitourinary and the Latin American Renal Cancer Group: Focus on Surgery. Ther Adv Urol. 2019;11:1756287219872324.
  8. Soares A, Monteiro FSM, Maluf FC, et al. Advanced renal cell carcinoma (RCC) management: an expert panel recommendation from the Latin American Cooperative Oncology Group (LACOG) and the Latin American Renal Cancer Group (LARCG). J Cancer Res Clin Oncol. 2020;146(7):1829-1845.
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