Abstract
Background
Few data factually support the prognostic distinction between renal cell carcinomas (RCC) < 2 vs. 2.1–4 cm, in terms of cancer-specific mortality (CSM). We investigated CSM rates over time in <2 vs. 2.1–4 cm RCC, according to patient and tumor characteristics.
Methods
Within the Surveillance, Epidemiology and End Results (SEER) database, we focused on patients with T1aN0M0 RCC who underwent either radical or partial nephrectomy between 2000 and 2015. Temporal trends, Kaplan-Meier plots and multivariable Cox-regression analyses assessed CSM.
Results
Of 43,147 T1aN0M0 patients, 12,238 (28.4%) harbored RCC < 2 cm and 30,909 (71.6%) 2.1–4 cm RCC. The distribution of histological subtypes according to 2 cm cut-off was as follows: a). clear-cell G1/G2: 64.5 vs. 61.8%; b). papillary G1/G2 15.9 vs. 11.1%; c). clear-cell G3/G4: 9.9 vs. 16.1%; d). papillary G3/G4 4.9 vs. 5.4%; and e). chromophobe 4.9 vs. 5.2%. Five-year CSM rates were invariably lower in RCC < 2 cm than in 2.1–4 cm, for all histological subtypes and grade groups (a-e), even after additional multivariable adjustment for age and residual tumor size differences. 5-year CSM rates improved in more contemporary years, in both tumor size groups (< 2 vs. 2.1–4 cm), but to a greater extent in 2.1–4 cm renal masses.
Conclusion
Our results validate the presence of prognostically more favorable CSM outcomes in RCC < 2 cm vs. 2.1–4 cm, across all histological subtypes and grades. Moreover, temporal improvements were also recorded in both <2 and 2.1–4 cm RCC groups, with more pronounced improvements in patients with 2.1–4 cm renal masses. However, prospective randomized trials are needed to further confirm our results.
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References
Nguyen MM, Gill IS, Ellison LM (2006) The evolving presentation of renal carcinoma in the United States: trends from the surveillance, epidemiology, and end results program. J Urol 176:2397–2400. https://doi.org/10.1016/j.juro.2006.07.144
Patel HD, Gupta M, Joice GA, Srivastava A, Alam R, Allaf ME et al (2019) Clinical stage migration and survival for renal cell carcinoma in the United States. Eur Urol Oncol 2:343–348. https://doi.org/10.1016/j.euo.2018.08.023
Luzzago S, Palumbo C, Rosiello G, Knipper S, Pecoraro A, Mistretta FA et al (2020) Effect of stage and grade migration on cancer specific mortality in renal cell carcinoma patients, according to clear cell vs. non-clear cell histology: a contemporary population-based analysis. Urol Oncol Semin Original Invest 38:506–514. https://doi.org/10.1016/j.urolonc.2020.02.004
Palumbo C, Pecoraro A, Rosiello G, Luzzago S, Deuker M, Stolzenbach F et al (2020) Renal cell carcinoma incidence rates and trends in young adults aged 20-39 years. Cancer Epidemiol 67:101762. https://doi.org/10.1016/j.canep.2020.101762
Capitanio U, Bensalah K, Bex A, Boorjian SA, Bray F, Coleman J et al (2019) Epidemiology of renal cell carcinoma. Eur Urol 75:74–84. https://doi.org/10.1016/j.eururo.2018.08.036
Sun M, Becker A, Tian Z, Roghmann F, Abdollah F, Larouche A et al (2014) Management of localized kidney cancer: calculating cancer-specific mortality and competing risks of death for surgery and nonsurgical management. Eur Urol 65:235–241. https://doi.org/10.1016/j.eururo.2013.03.034
Rosiello G, Palumbo C, Deuker M, Stolzenbach LF, Tian Z, Larcher A et al (2020) Preoperative frailty predicts adverse short-term postoperative outcomes in patients treated with radical nephroureterectomy. J Surg Oncol 121:688–696. https://doi.org/10.1002/jso.25840
Rosiello G, Palumbo C, Knipper S, Pecoraro A, Luzzago S, Deuker M et al (2020) Contemporary conditional cancer-specific survival after radical nephroureterectomy in patients with nonmetastatic urothelial carcinoma of upper urinary tract. J Surg Oncol:1–8. https://doi.org/10.1002/jso.25877
Mir MC, Capitanio U, Bertolo R, Ouzaid I, Salagierski M, Kriegmair M et al (2018) Role of active surveillance for localized small renal masses. Eur Urol Oncol 1:177–187. https://doi.org/10.1016/j.euo.2018.05.001
Campbell SC, Khanna A, Almassi N, Abouassaly R (2018) Active surveillance for localized small renal masses : current perspectives. Eur Urol Oncol 1:188–189. https://doi.org/10.1016/j.euo.2018.05.012
Motzer RJ, Jonasch E, Agarwal N, Bhayani S, Bro WP, Chang SS et al (2017) Kidney Cancer, version 2.2017: clinical practice guidelines in oncology. J Natl Compr Cancer Netw 15:804–834. https://doi.org/10.6004/jnccn.2017.0100
Eissa A, El Sherbiny A, Martorana E, Pirola GM, Puliatti S, Scialpi M et al (2018) Non-conservative management of simple renal cysts IN adults: a comprehensive review of literature. Minerva Urol Nefrol 70:179–192. https://doi.org/10.23736/S0393-2249.17.02985-X
Palumbo C, Pecoraro A, Knipper S, Rosiello G, Luzzago S, Deuker M et al (2020) Contemporary age-adjusted incidence and mortality rates of renal cell carcinoma: analysis according to gender, race, stage, grade, and histology. Eur Urol Focus:1–9. https://doi.org/10.1016/j.euf.2020.05.003
Preisser F, Marchioni M, Nazzani S, Bandini M, Tian Z, Saad F et al (2018) Trend of adverse stage migration in patients treated with radical prostatectomy for localized prostate Cancer. Eur Urol Oncol 1:160–168. https://doi.org/10.1016/j.euo.2018.03.006
Sika-Paotonu D, Bethwaite PB, McCredie MRE, William Jordan T, Delahunt B (2006) Nucleolar grade but not Fuhrman grade is applicable to papillary renal cell carcinoma. Am J Surg Pathol 30:1091–1096. https://doi.org/10.1097/01.pas.0000209833.69972.2b
Salagierski M, Wojciechowska A, Zając K, Klatte T, Thompson RH, Cadeddu JA et al (2018) The role of ablation and minimally invasive techniques in the management of small renal masses. Eur Urol Oncol 1:395–402. https://doi.org/10.1016/j.euo.2018.08.029
Bhindi B, Thompson RH, Lohse CM, Mason RJ, Frank I, Costello BA et al (2018) The probability of aggressive versus indolent histology based on renal tumor size: implications for surveillance and treatment. Eur Urol 74:489–497. https://doi.org/10.1016/j.eururo.2018.06.003
Remzi M, Özsoy M, Klingler HC, Susani M, Waldert M, Seitz C et al (2006) Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol 176:896–899. https://doi.org/10.1016/j.juro.2006.04.047
Duchene DA, Lotan Y, Cadeddu JA, Sagalowsky AI, Koeneman KS (2003) Histopathology of surgically managed renal tumors: analysis of a contemporary series. Urology 62:827–830. https://doi.org/10.1016/S0090-4295(03)00658-7
Patel HD, Semerjian A, Gupta M, Pavlovich CP, Johnson MH, Gorin MA et al (2019) Surgical removal of renal tumors with low metastatic potential based on clinical radiographic size: a systematic review of the literature. Urol Oncol Semin Original Invest 37:519–524. https://doi.org/10.1016/j.urolonc.2019.05.013
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Rosiello, G., Pecoraro, A., Luzzago, S. et al. Prognostic factors in patients with small renal masses: a comparison between <2 vs. 2.1–4 cm renal cell carcinomas. Cancer Causes Control 32, 119–126 (2021). https://doi.org/10.1007/s10552-020-01364-3
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DOI: https://doi.org/10.1007/s10552-020-01364-3