PD52-08 CAN LOOKS DECEIVE? NOT ALL CLINICALLY “CYSTIC” RENAL MASSES HARBOR INDOLENT BIOLOGY

Abstract

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging III1 Apr 2017PD52-08 CAN LOOKS DECEIVE? NOT ALL CLINICALLY “CYSTIC” RENAL MASSES HARBOR INDOLENT BIOLOGY Benjamin Ristau, Lyudmila DeMora, Eric Ross, Randall Lee, Michael Haifler, Shreyas Joshi, Andres Correa, David Chen, Richard Greenberg, Rosalia Viterbo, Marc Smaldone, Robert Uzzo, and Alexander Kutikov Benjamin RistauBenjamin Ristau More articles by this author , Lyudmila DeMoraLyudmila DeMora More articles by this author , Eric RossEric Ross More articles by this author , Randall LeeRandall Lee More articles by this author , Michael HaiflerMichael Haifler More articles by this author , Shreyas JoshiShreyas Joshi More articles by this author , Andres CorreaAndres Correa More articles by this author , David ChenDavid Chen More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2196AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cystic renal cell carcinomas (RCC) are suggested to be clinically indolent. As such, a distinct pathologic staging category for these lesions was recently proposed. While not without merit, these recommendations fail to account for limitations in the ability of modern imaging to differentiate cystic RCC from more biologically aggressive mimics. We evaluated the frequency of high grade kidney cancer in the highly selected cohort of surgically resected renal masses having cystic appearance on pre-operative radiographic imaging. METHODS A prospectively maintained institutional database was queried for clinically cystic renal masses that underwent surgery from January 2000 - June 2016 (n=2,729 kidney surgeries). Patient and tumor characteristics including age at surgery, smoking history, Charlson comorbidity index (CCI), gender, race, BMI, surgery date, laterality, Bosniak classification, histology, grade, size, and nearness to the collecting system were tabulated. Associations between tumor grade and patient/tumor characteristics were evaluated using generalized estimating equations. RESULTS Eighty-nine patients (n=101 cystic lesions) met strict inclusion criteria; the majority (77%) were older than 50 years of age and the mean Charlson comorbidity index was 1.15 (SD1.48) (Table 1). Of the 101 clinically cystic renal masses, 23% were confirmed pathologically as high grade RCC while 77% were low grade RCC (n=56) or benign (n=22). CCI was associated with high grade surgical pathology (OR 1.37, 95% CI 1.05-1.79, p = 0.02). There was no association between tumor grade and the remainder of the patient/tumor characteristics analyzed. CONCLUSIONS Recently proposed changes to the kidney cancer staging system define a tumor's cystic nature based on pathologic examination. Proceeding with surgery for a radiographically “cystic” renal mass was a rare event in our cohort; however, among those that went onto surgery, nearly a quarter harbored high grade pathology. Before making changes to the clinical RCC staging system, a better understanding of the limitations inherent to radiographic determination of low malignant potential, cystic renal masses is necessary. © 2017FiguresReferencesRelatedDetailsCited byRistau B and Kutikov A (2017) Editorial CommentJournal of Urology, VOL. 199, NO. 3, (639-640), Online publication date: 1-Mar-2018. Volume 197Issue 4SApril 2017Page: e992 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Benjamin Ristau More articles by this author Lyudmila DeMora More articles by this author Eric Ross More articles by this author Randall Lee More articles by this author Michael Haifler More articles by this author Shreyas Joshi More articles by this author Andres Correa More articles by this author David Chen More articles by this author Richard Greenberg More articles by this author Rosalia Viterbo More articles by this author Marc Smaldone More articles by this author Robert Uzzo More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...