Abstract
BackgroundThe observed low metastatic potential and favorable survival of small incidentally detected renal cell carcinomas (RCCs) have been a part of the rationale for recommending partial nephrectomy as a first treatment option and active surveillance in selected patients. We examined the relationship between tumor size and the odds of synchronous metastases (SMs) (primary outcome) and disease specific survival (secondary outcome) in a nationwide RCC registry.MethodsRetrospective study of the 794 RCC patients diagnosed in Iceland between 1971 and 2005. Histological material and TNM staging were reviewed centrally. The presence of SM and survival were recorded. Cubic spline analysis was used to assess relationship between tumor size and probability of SM. Univariate and multivariate statistics were used to estimate prognostic factors for SM and survival.ResultsThe probability of SM increased in a non-linear fashion with increasing tumor size (11, 25, 35, and 50%) for patients with tumors of ≤4, 4.1-7.0, 7.1-10.0, and >10 cm, respectively. On multivariate analysis, tumor size was an independent prognostic factor for disease-specific survival (HR = 1.05, 95% CI 1.02-1.09, p < 0.001), but not for SM.ConclusionTumor size affected the probability of disease-specific mortality but not SM, after correcting for TNM staging in multivariate analysis. This confirms the prognostic ability of the 2010 TNM staging system for renal cell cancer in the Icelandic population.
Highlights
The observed low metastatic potential and favorable survival of small incidentally detected renal cell carcinomas (RCCs) have been a part of the rationale for recommending partial nephrectomy as a first treatment option and active surveillance in selected patients
The ability to detect subclinical small renal cell carcinomas (RCCs) has greatly improved due to increased usage of abdominal imaging for unrelated disease [1]. This has altered the therapeutic approach to RCCs and over the past decade, nephron-sparing surgery (NSS) has replaced radical nephrectomy as the preffered treatment for RCCs less than 7 cm in size, when technically feasible, as suggested by both the European and American Guidelines [2,3]
Altogether, 913 patients were diagnosed with RCC during the 35 year study period, but 116 patients were excluded; 65 because detailed information on tumor size was lacking and 51 cases that only were clinically diagnosed as RCC
Summary
The observed low metastatic potential and favorable survival of small incidentally detected renal cell carcinomas (RCCs) have been a part of the rationale for recommending partial nephrectomy as a first treatment option and active surveillance in selected patients. The ability to detect subclinical small renal cell carcinomas (RCCs) has greatly improved due to increased usage of abdominal imaging for unrelated disease [1]. This has altered the therapeutic approach to RCCs and over the past decade, nephron-sparing surgery (NSS) has replaced radical nephrectomy as the preffered treatment for RCCs less than 7 cm in size, when technically feasible, as suggested by both the European and American Guidelines [2,3]. The 2010 revision of the TNM system emphasized size by subdividing the T2 stage into T2a and T2b catergories at the 10-cm cut-off point, subsequent publications have questioned any prognostic difference between the two new stages [13,14]
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