637 PREOPERATIVE DECISION-MAKING FOR RENAL CELL CARCINOMA: CYSTIC MORPHOLOGY IN CROSS SECTIONAL IMAGING PREDICTS LOWER MALIGNANT POTENTIAL

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation & Staging (I)1 Apr 2013637 PREOPERATIVE DECISION-MAKING FOR RENAL CELL CARCINOMA: CYSTIC MORPHOLOGY IN CROSS SECTIONAL IMAGING PREDICTS LOWER MALIGNANT POTENTIAL Johannes Huber, Alexandra Winkler, Thomas Bruckner, Wilfried Roth, Peter Hallscheidt, Keivan Daneshvar, Markus Hohenfellner, and Sascha Pahernik Johannes HuberJohannes Huber Heidelberg, Germany More articles by this author , Alexandra WinklerAlexandra Winkler Heidelberg, Germany More articles by this author , Thomas BrucknerThomas Bruckner Heidelberg, Germany More articles by this author , Wilfried RothWilfried Roth Heidelberg, Germany More articles by this author , Peter HallscheidtPeter Hallscheidt Heidelberg, Germany More articles by this author , Keivan DaneshvarKeivan Daneshvar Heidelberg, Germany More articles by this author , Markus HohenfellnerMarkus Hohenfellner Heidelberg, Germany More articles by this author , and Sascha PahernikSascha Pahernik Heidelberg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.189AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several histologic studies showed more favorable oncologic outcome for renal cell carcinoma (RCC) with cystic change. However, there is no prognostic tool to judge on cystic RCC preoperatively. We hypothesized, that cystic morphology in cross sectional imaging predicts lower malignant potential. METHODS From our prospectively conducted oncologic database we identified 825 patients who underwent surgery for RCC from 2001 through 2011. In 348 cases (42%) adequate imaging was available for independent review by two radiologists. We excluded recurrent and synchronous bilateral RCC, familial syndromes, collecting duct carcinoma, and metastases. For the resulting 319 patients we compared clinical, pathological, and survival outcomes. RESULTS Median age was 63 (19-88) years and 220 (69%) patients were male. Median follow-up was 1.7 (0-9.8) years. Of 319 renal masses 277 (86.8%) were solid and 42 (13.2%) were cystic. In cystic RCC median tumor diameter was lower (3 cm vs 4 cm, p=0.002), and nephron-sparing surgery was more frequent (69% vs 41.5%, p=0.002). None of the patients with cystic RCC and 56 (20.2%) with solid RCC had synchronous systemic disease (p=0.001). The nuclear grade of cystic RCC was more favorable (p=0.002). Patients with cystic RCC showed better overall (p=0.049) and cancer-specific survival (p=0.027). In a multivariate model only synchronous metastases, positive R-status, and greater tumor diameter were independent risk factors (p≤0.03). CONCLUSIONS We report the first study to show, that cystic morphology in cross sectional imaging predicts RCC with a lower malignant potential. This insight might allow less invasive treatment strategies in selected patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e260 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johannes Huber Heidelberg, Germany More articles by this author Alexandra Winkler Heidelberg, Germany More articles by this author Thomas Bruckner Heidelberg, Germany More articles by this author Wilfried Roth Heidelberg, Germany More articles by this author Peter Hallscheidt Heidelberg, Germany More articles by this author Keivan Daneshvar Heidelberg, Germany More articles by this author Markus Hohenfellner Heidelberg, Germany More articles by this author Sascha Pahernik Heidelberg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...