Postoperative Outcome of Cystic Renal Cell Carcinoma Defined on Preoperative Imaging: A Retrospective Study

To evaluate postoperative outcome of cystic renal cell carcinoma (RCC) defined on preoperative computed tomography (CT), and to find the optimal cut-off of cystic cystic proportion in association with patients' prognosis.

In this institutional review board-approved study with waiver of informed consent, a total of 1315 patients who received surgery for single RCC with pre-operative CT were enrolled. The cystic proportion of RCC was determined on CT. The optimal cut-off of cystic proportion was explored regarding cancer-specific survival. The RCCs were categorized as cystic or non-cystic RCCs according to conventional (i.e. cystic proportion ≥ 75%) and the optimal cut-off, and then post-operative outcomes were compared between the two groups. Multivariate Cox regression analysis was performed to determine the independent predictor for cancer-specific survival.

Of the 1315 lesions, 107 (8.1%) were identified as cystic RCCs according to a conventional cut-off. Postoperative outcome of cystic RCC was significantly better than that of non-cystic RCC (P<0.001). Neither metastasis nor recurrence in patients with cystic RCC was developed after surgery. In association with cancer-specific survival rate, the optimal cut-off of cystic proportion was 45%, and 197 (15.0%) were defined as cystic RCCs accordingly. On Cox regression analysis, cystic proportion ≥ 45% in RCC was an independent predictor of favorable outcome regarding cancer-specific survival (hazard ratio 0.34, P = 0.03).

Cystic RCC defined on preoperative CT is associated with low metastatic potential and favorable outcomes after surgery. Particularly, cystic proportion ≥ 45% is an independent prognostic factor for favorable survival.

The Journal of urology. 2016 Oct 17 [Epub ahead of print]

Jung Jae Park, Byong Chang Jeong, Chan Kyo Kim, Seong Il Seo, Keumhee C Carriere, Minji Kim, Byung Kwan Park, Seong Soo Jeon, Hyun Moo Lee, Han Yong Choi

Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; School of Medicine, Kangwon National University, Chuncheon, Korea., Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea., Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea. Electronic address: ., Department of Biostatistics and Clinical Epidemiology Center, Samsung Hospital, Seoul, Korea and Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada., Department of Biostatistics and Clinical Epidemiology Center, Samsung Hospital, Seoul, Korea., Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

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