Organ‐confined clear cell renal cell carcinoma: the prognostic impact of microvascular invasion, nuclear grade and tumour size

Zubac, Damir; Bostad, Leif; Kihl, Björn; Eide, Johan; Wentzel‐Larsen, Tore; Haukaas, Svein A.

doi:10.1111/j.1600-0463.2008.01071.x

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…Nuclear grading as per the Fuhrman grading system should be assigned because it is one of the most important prognostic factors in organ-confined carcinoma [20] and because some authors advocate that in elderly and unfit patients, low-grade carcinoma can be initially observed or ablated rather than operated on, while the former treatments are not appropriate for high-grade RCC [7]. However, the concordance is low (less than 50 %) between the grades assessed on paired biopsies and surgical specimens, reflecting intratumor heterogeneity [21].…”

Section: Clear Cell Renal Cell Carcinomamentioning

confidence: 99%

Interpretation of needle biopsies of the kidney for investigation of renal masses

Lhermitte

Leval

2012

Virchows Arch

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The development of new therapeutic options for renal tumors has lead to the need of a pretherapeutic diagnosis for an increasing proportion of patients presenting with a renal mass. This need is particularly important for a small, incidentally discovered renal mass (less than 4 cm) as it can be a benign lesion in a significant percentage of cases. Recent studies have shown that needle biopsy is an accurate and safe method allowing for a precise histopathological diagnosis of the mass in most cases. The aims of the biopsy are (1) to assess the benign or malignant nature of the lesion, (2) to assess the primary or secondary nature of the lesion, and (3), in case of a primary malignancy, to determine histological prognostic factors, such as the tumor type. This review, based on the most recent literature and our own experience, is intended to provide a practical approach to the diagnosis, relying on appropriate morphologic assessment and the use of immunohistochemistry.

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Section: Clear Cell Renal Cell Carcinomamentioning

confidence: 99%

Interpretation of needle biopsies of the kidney for investigation of renal masses

Lhermitte

Leval

2012

Virchows Arch

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“…The incidence of asymptomatic small renal masses (SRMs), i.e. those <4.0 cm, has increased substantially, owing to more prevalent use of cross‐sectional imaging, and they now represent a common clinical scenario for the practising urologist . Previously, all solid renal masses were presumed to be malignant and managed aggressively, most often with radical nephrectomy.…”

Section: Introductionmentioning

confidence: 99%

Assessing the anatomical characteristics of renal masses has a limited effect on the prediction of pathological outcomes in solid, enhancing, small renal masses: results using the PADUA classification system

et al. 2013

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Objective• To evaluate whether assessing the anatomical characteristics of renal masses increases the accuracy of prediction of tumour pathology in small renal masses (SRMs). Patients and Methods• We retrospectively reviewed 1129 consecutive patients who underwent extirpative surgeries for a clinical T1 renal mass, for which the preoperative aspects and dimensions used for an anatomical (PADUA) classification were available.• Multivariate logistic regression analyses of demographic and anatomical characteristics were performed. • Nomograms to predict malignancy and high grade pathology were constructed using a basic model (age, sex and tumour size), and an extended model (anatomical characteristics incorporated into the basic model), and the area under the curve (AUC) between models was compared. Results• Age, sex and tumour size were significantly associated with malignancy and high grade pathology in the T1 and T1a category (except sex for high grade pathology in T1a tumours). Exophytic rate (T1 and T1a) and renal sinus or urinary collecting system involvement (only T1a) were also significant predictors of high grade pathology.• Nomograms using the extended model for malignancy showed an insignificant AUC increase compared with those using the basic model (T1, from 0.771 to 0.780, P = 0.149, and T1a, from 0.803 to 0.819, P = 0.055).• For high grade pathology, the extended model achieved a significant AUC increase (from 0.595 to 0.643, P = 0.014) in the T1a category, but the AUC for both T1 and T1a tumours showed merely modest competence (0.654 and 0.643, respectively). Conclusion• Age, sex and tumour size are the primary predictors of tumour pathology of SRMs, and incorporating other anatomical characteristics has only a limited positive effect on the accuracy of prediction of pathological outcomes.

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“…However, even with increased detection, the independent predictive capability of MVI and CLI after multivariate analysis is mixed. 9,15,17,18 In the current study, MVI and CLI were assessed using hemotoxylin and eosin staining only, to reflect standard clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Numerous studies have evaluated the effect of MVI on metastasis-free survival (MFS) and cancer-specific survival (CSS) with variable results, however most have been constrained by a limited sample size or lack of centralized pathologic review. 8-18 …”

Section: Introductionmentioning

confidence: 99%

Association of Microvascular and Capillary-Lymphatic Invasion with Outcome in Patients with Renal Cell Carcinoma

et al. 2013

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Purpose We evaluated the association of microvascular invasion (MVI) and capillary-lymphatic invasion (CLI) with patient outcome following nephrectomy for renal cell carcinoma (RCC). Material and Methods We identified 1,433 patients surgically treated for sporadic, unilateral RCC between 2001 and 2008. All specimens were reviewed by a single uropathologist for MVI and CLI. Associations with time to metastases and death from RCC were evaluated using Cox proportional hazards models, controlling for established clinicopathologic prognostic variables. Results MVI and CLI were identified in 11% (119/1,103) and 2% (17/1,103) with clear cell, 2% (5/219) and <1% (1/219) with papillary, and 1% (1/86) and 0 with chromophobe RCC, respectively. Median follow-up for patients still alive was 6.4 years (range 0-11). In clear cell RCC, MVI was univariately associated with an increased risk of metastases (HR 3.5,p<0.001) and cancer-specific death (HR 3.0,p<0.001). However, on multivariate analyses, these associations were no longer statistically significant (HR 1.2,p=0.4 and HR 1.3,p=0.1, respectively). CLI remained significantly associated with an increased risk of metastases and death both univariately (HR 15.9,p<0.001 and HR 11.6,p<0.001, respectively) and on multivariate analyses (HR 3.2,p<0.001 and HR 3.1,p<0.001, respectively). Conclusions MVI is associated with an increased risk of metastases and cancer death for patients with clear cell RCC, although this does not remain significant after controlling for established prognostic variables. Meanwhile, CLI appears to be independently associated with metastases and cancer death even after controlling for known prognostic risk factors; however, given its rarity, this feature may prove to be of limited clinical significance.

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Organ‐confined clear cell renal cell carcinoma: the prognostic impact of microvascular invasion, nuclear grade and tumour size

Cited by 4 publications

References 20 publications

Interpretation of needle biopsies of the kidney for investigation of renal masses

Interpretation of needle biopsies of the kidney for investigation of renal masses

Assessing the anatomical characteristics of renal masses has a limited effect on the prediction of pathological outcomes in solid, enhancing, small renal masses: results using the PADUA classification system

Association of Microvascular and Capillary-Lymphatic Invasion with Outcome in Patients with Renal Cell Carcinoma

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