Comparison between small renal masses 0-2 cm vs. 2.1-4 cm in size: A population-based study |
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| Authors: | Angela Pecoraro Marina Deuker Giuseppe Rosiello Franziska Stolzenbach Stefano Luzzago Zhe Tian Shahrokh F. Shariat Fred Saad Alberto Briganti Anil Kapoor Cristian Fiori Francesco Porpiglia Pierre I. Karakiewicz |
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| Affiliation: | 1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada;2. Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy;3. Department of Urology, University Hospital Frankfurt, Frankfurt, Germany;4. Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy;5. Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;6. Department of Urology, European Institute of Oncology, Milan, Italy;7. Department of Urology, Medical University of Vienna, Vienna, Austria;8. Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic;9. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;10. Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada;11. Division of Urology, McMaster University, Hamilton, Ontario, Canada |
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| Abstract: | ![]()
BackgroundThe NCCN guidelines recommend active surveillance (AS) as an option for the initial management of cT1a 0-2 cm renal lesions. However, data about comparison between renal cell carcinoma (RCC) 0-2 cm vs. 2.1-4 cm are scarce.MethodsWithin the Surveillance, Epidemiology, and End Results database (2002–2016), 46,630 T1a NanyMany stage patients treated with nephrectomy were identified. Data were tabulated according to histological subtype, tumor grade (low [LG] vs. high [HG]), as well as age category and gender. Additionally, rates of synchronous metastases were quantified.ResultsOverall, 69.3 vs. 74.1% clear cell, 21.4 vs. 17.6% papillary, 6.9 vs. 6.8% chromophobe, 2.0 vs. 1.1% sarcomatoid dedifferentiation, 0.2 vs. 0.2% collecting duct histological subtype were identified for respectively 0-2 cm and 2.1-4 cm RCCs. In both groups, advanced age was associated with higher rate of HG clear cell and HG papillary histological subtype. In 0-2 cm vs. 2.1-4 cm RCCs, 13.8% vs. 20.2% individuals operated on harbored HG tumors and were more prevalent in males. Lower synchronous metastases rates were recorded in 0-2 cm RCC and ranged from 0 in respectively multilocular cystic to 0.9% in HG papillary histological subtype. The highest synchronous metastases rates were recorded in sarcomatoid dedifferentiation histological subtype (13.8% and 9.7%) in both groups.ConclusionsRelative to 2.1-4 cm RCCs, 0-2 cm RCCs harbored lower rates of HG tumors, lower rates of aggressive variant histology and lower rates of synchronous metastases. The indications and demographics of patients selected for AS may be expanded in the future to include younger and healthier patients. |
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