Prognostic significance of indeterminate lung nodules in renal cell carcinoma.

Abstract

377 Background: Many patients with newly diagnosed renal cell carcinoma (RCC) are found to have indeterminate lung nodules at the time of diagnosis. Current guidelines are vague about the necessity and frequency of additional chest imaging. We sought to determine whether the presence of indeterminate lung nodules at the time of diagnosis affects long-term survival for patients with early stage RCC. Methods: A retrospective review was performed of all patients at our institution who underwent nephrectomy for stage I-III RCC between 2001 and 2006 and had baseline chest imaging available for review. Presence of indeterminate lung nodule(s) on preoperative chest imaging was determined, along with tumor stage, grade, and histology; patient age, gender, body mass index, and smoking status; and Charlson comorbidity score. The time from diagnosis to last documented follow-up, and to first detected metastasis and/or death if applicable, was determined. Univariate and multivariate analyses were performed. The primary outcome of interest was disease-free survival; the secondary outcome was overall survival. The study follow-up period extended to July 2012. Results: In a multivariate analysis of 240 patients, disease-free survival was significantly associated with the presence of indeterminate lung nodules (HR 1.900, 95% CI: [1.042, 3.463]; p = 0.036). The number and size of the nodules did not add statistical significance. Disease-free survival was also associated with tumor stage (stage II: HR 5.611, p < 0.001; stage III: HR 2.488, p = 0.0129) and grade (HR 2.433 for grade 3 or 4, p = 0.005). Overall survival was only associated with Charlson comorbidity score (HR 1.294, p < 0.0001) and primary tumor size (HR 1.287, p < 0.0001). Conclusions: The presence of indeterminate lung nodules at the time of diagnosis of RCC had a negative impact on disease-specific survival. Tumor stage and grade were also significant prognostic factors. These findings underscore the importance of baseline chest imaging as well as vigilant surveillance of patients in whom lung nodules are identified.