Incidental and symptomatic renal tumors: impact on patient survival

Incidental vs symptomatic renal tumours: Survival outcomes

Purpose

Currently there is an increase in the incidental diagnosis of renal cell carcinoma (RCC). Our aim was to assess the survival of patients with incidental and symptomatic renal tumours who had undergone nephrectomy.

Patients and methods

We retrospectively assessed 604 patients who underwent renal surgery for RCC between 1983 and 2005. Patients were divided in two groups; group 1 had incidental and group 2 had symptomatic tumours. The median follow-up was 4 and 3.3 years for groups 1 and 2, respectively. All patients had surgery in the form of radical or partial nephrectomy. Sex, age, tumour size, type of surgery, pathological characteristics and patient survival in both groups were evaluated. The statistical analysis included the log-rank, Kaplan–Meier and Cox regression tests.

Results

There were 85 patients (14%) in group 1 (mean age 49.6 years) and 519 (86%) in group 2 (mean age 50 years). The mean (SEM, range) tumour size was 7.4 (0.4, 1.5–20) cm in group 1 and 9.7 (0.2, 2–38) cm in group 2 (P < 0.001). The most common stage was T1 (52%) and T2 (44%) in groups 1 and 2, respectively, with a predominance of G2 grade and the conventional type histology in both the groups. There was a significant difference in cancer-specific survival (CSS) between the groups (log-rank, P = 0.017). The 5- and 10-year CSS was 94% and 94% for group 1, and 82.5% and 79.5% for group 2. Cox regression analysis showed that in group 1, only the tumour mid-zonal location (P = 0.093), tumour stage pT (P < 0.001), grade 1 (P = 0.03), grade 2 (P = 0.01), grade 4 (P = 0.01) and the papillary histological type (P = 0.019) had significant effects on CSS. In group 2, only tumour size (P = 0.022) and stage pN (P = 0.003) had significant effects on CSS. The tumour recurrence rate was 18% and 29% for groups 1 and 2, respectively.

Conclusions

This large study supports the findings of other smaller studies published previously, confirming that at presentation incidental renal tumours are smaller and their diagnosis provides a better prognosis and longer CSS.

Localized renal cell carcinoma management: an update

OBJECTIVE

To review the current modalities of treatment for localized renal cell carcinoma.

MATERIALS AND METHODS

A literature search for keywords: renal cell carcinoma, radical nephrectomy, nephron sparing surgery, minimally invasive surgery, and cryoablation was performed for the years 2000 through 2008. The most relevant publications were examined.

RESULTS

New epidemiologic data and current treatment of renal cancer were covered. Concerning the treatment of clinically localized disease, the literature supports the standardization of partial nephrectomy and laparoscopic approaches as therapeutic options with better functional results and oncologic success comparable to standard radical resection. Promising initial results are now available for minimally invasive therapies, such as cryotherapy and radiofrequency ablation. Active surveillance has been reported with acceptable results, including for those who are poor surgical candidates.

CONCLUSIONS

This review covers current advances in radical and conservative treatments of localized kidney cancer. The current status of nephron-sparing surgery, ablative therapies, and active surveillance based on natural history has resulted in great progress in the management of localized renal cell carcinoma.

Renal cell carcinoma: Impact of mode of detection on its pathological characteristics

Objective : Data correlating mode of presentation of renal cell carcinoma (RCC) with pathological prognostic factors is sparse from India. We compared RCC presenting incidentally with those presenting symptomatically with respect to pathological prognostic factors and assessed whether this could serve as a decision making resource for diagnosing small and more favorable tumors. Materials and Methods : The data were reviewed for 328 patients operated for renal tumors between January 2000 and October 2008 at our institute. The pathological factors (tumor size, stage, grade, histopathological type) in relation to the mode of presentation were analyzed according to 1997 TNM criteria. Statistical analysis was performed via the chi-square (Fisher exact) and Mann -Whitney U test. The statistical significance level utilized was P < 0.05. Results : Among the patients assessed, 93 (28.4%) had incidental diagnosis and 235 (71.6%) had symptomatic presentation. Sex and side distribution was not significantly different in the two groups. Mean tumor size was 5.75 +/- 2.73 cm in incidentally detected RCC (IRCC) and 9.32 +/- 3.70 (P < 0.001) in symptomatic RCC (SRCC). Stage I and II tumors were significantly greater in IRCC than SRCC (P < 0.001 and 0.005 respectively) whereas stage III and IV tumors were significantly less in IRCC than SRCC. There was a predominance of higher grade tumors in SRCC, 50% being higher grades (Fuhrman's grade III and IV) in SRCC than 28.1% in IRCC (P = 0.003). There were 4 tumors with collecting duct histology in SRCC and none in IRCC. Sarcomatoid differentiation was present in 14 and 1 patient in SRCC and IRCC respectively. Conclusion : Incidental detection of renal carcinoma as compared to symptomatic tumors is lower in India as compared to western world. Incidental tumors have significantly favorable pathological prognostic factors. Our results might form a basis for further studies on how to pick RCC at an earlier stage.