SAN DIEGO, CA USA (UroToday.com) - Chest CT is often a part of a routine evaluation and staging of patients with kidney cancer, and incidental identification of indeterminate pulmonary nodules is not uncommon.
Dr. Patrick Kinney and colleagues evaluated the natural history of such nodules in a single-institution cohort of patients undergoing radical nephrectomy between 2005 and 2009, and assessed the association with future development of lung metastases.
The authors identified patients with ≥ 1 indeterminate non-calcified pulmonary lesion on chest CT within 6 months of the intervention and with no evidence of distant metastatic disease. Only patients with RCC and without another metastatic primary malignancy were included (N=249). Pulmonary metastases developed in 62 patients (21.5%) with female gender (74.2 vs 59.4%, p=0.036), ECOG ≥ 1 (37.1% vs 14.5%, p=0.001), symptomatic presentation (42.2 vs 12.9%, p < 0001), larger primary tumors (median 8.6 vs 7.0 cm, p < 0.001), higher serum creatinine (median 1.2 vs 1.0 mg/dL, p=0.008), and lower hemoglobin (median 12.8 vs 13.4 g/dL, p = 0.001) demonstrating significant association on univariable analysis. While those who developed pulmonary metastases had more indeterminate nodules (4 vs 3, p=0.003) and larger maximum nodule size (5.0 vs 4.0 mm, p=0.007), presence of co-existing effusion or calcified nodules did not exhibit statistically significant association with pulmonary metastasis in this cohort. Multivariable analysis identified larger primary tumor size (OR 1.16, p=0.01), ECOG performance status ≥ 1 (OR 2.76, p=-0.019) and female gender (OR 2.22, p=0.046) to be significantly associated with increased risk of developing future pulmonary metastases.
In summary, more than 20% of patients with indeterminate pulmonary nodules developed pulmonary metastases, risk factors for which include tumor size, female gender, and poor performance status. This information, after further validation, may enhance pre-operative patient counseling and individualize post-operative surveillance imaging protocols.
Presented by Patrick Kenney, Jose Karam, Ryan Levey, Graciela Nogueras-Gonzalez, Surena Matin, Pheroze Tamboli, Nizar Tannir, and Christopher Wood at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Serge Ginzburg, MD
