The impact of tumour location on the histological subtype of renal cortical tumours

Schachter, Lee R.; Bach, Ariadne M.; Snyder, Mark E.; Kattan, Michael W.; Russo, Paul

doi:10.1111/j.1464-410x.2006.06179.x

Cited by 42 publications

(15 citation statements)

References 39 publications

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“…Similarly, multiple studies have demonstrated tumor location is correlated with biologic potentiation, with exophytic tumors exhibiting less malignant lesions and less clear cell histology. [22, 23] Together these studies along with the present study suggest that increasing anatomic complexity is associated with more aggressive biologic potential.…”

Section: Discussionsupporting

confidence: 74%

Preoperative predictors of malignancy and unfavorable pathology for clinical T1a tumors treated with partial nephrectomy: A multi-institutional analysis

Ball

Gorin

Bhayani

et al. 2015

Urologic Oncology: Seminars and Original Investigations

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Purpose To determine preoperative predictors associated with RCC and unfavorable pathology in small renal masses treated with partial nephrectomy (PN). Materials and Methods PN records from 5 centers were retrospectively queried for patients with a clinically localized, single tumor < 4 cm on imaging (cT1a). Between 2007 and 2013, 1009 patients met inclusion criteria. Unfavorable pathology was defined as any grade III or IV RCC or tumors upstaged to pathologic T3a disease. Logistic regression models were used to determine preoperative characteristics associated with RCC and with unfavorable pathology. Results A total of 771 (76.4%) patients were found to have RCC and 198 (19.6%) had unfavorable pathology. On multivariate, bootstrap-adjusted logistic regression analysis, factors associated with presence of malignancy were imaging tumor size > 3 cm (OR 1.46, p = 0.040), male sex (OR 1.88, p < 0.0001) and nephrometry score > 8 (OR 1.64, p = 0.005). These same factors were independently associated with risk of unfavorable pathology: size > 3 cm (OR 1.46, p=0.021), male sex (OR 2.35, p < 0.0001) and nephrometry score > 8 (OR 1.49, p =0.015). The c statistic was 0.62 for the predicting malignancy and 0.63 for unfavorable pathology. Conclusions In this multi-institutional cohort, male sex, imaging tumor size >3 cm, and nephrometry score >8 were predictors of RCC and adverse pathology following PN. These factors may assist in risk stratification and selective renal mass biopsy prior to decision making. Further studies are necessary to validate these findings.

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Section: Discussionsupporting

confidence: 74%

Preoperative predictors of malignancy and unfavorable pathology for clinical T1a tumors treated with partial nephrectomy: A multi-institutional analysis

Ball

Gorin

Bhayani

et al. 2015

Urologic Oncology: Seminars and Original Investigations

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“…Those treated with radical nephrectomy were more likely to have larger tumors, clear cell histology, and perinephric or renal sinus fat invasion, all features reported to increase the risk of cancer-specific death. 17-19 Furthermore, we also suggest that patients treated with partial nephrectomy in the current study were more likely to have exophytic tumors, which may be biologically less aggressive than more central or hilar renal masses, 20 perhaps due to the close proximity of the renal sinus with its associated rich network of veins and lymphatics. 21 Additionally, surgeon selection bias may have influenced the results in that more aggressive appearing tumors may have been selected for radical nephrectomy.…”

Section: Discussionmentioning

confidence: 61%

Partial Versus Radical Nephrectomy for 4 to 7 cm Renal Cortical Tumors

et al. 2009

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Purpose Recent observations suggest that partial nephrectomy for small renal tumors may be associated with improved survival compared with radical nephrectomy. We evaluated survival in patients with renal tumors 4-7cm using a bi-institutional collaboration. Methods Combining institutional databases from Mayo Clinic and Memorial Sloan-Kettering, we identified 1,159 patients with sporadic, unilateral, solitary and localized renal masses 4.1–7.0 cm who underwent radical or partial nephrectomy between 1989 and 2006. Patient outcome was compared using Cox proportional hazards regression models. Results Among the 1,159 patients, 873 (75%) and 286 (25%) were treated with radical and partial nephrectomy, respectively. Patients treated with partial (vs radical) nephrectomy were significantly more likely to have a solitary kidney (10% vs 0.2%, p<0.001) and chronic kidney disease (15% vs 7%, p<0.001). Median duration of follow-up for survivors was 4.8 years (range 0-19). There was not a significant difference in overall survival when comparing patients treated with radical and partial nephrectomy (p=0.8). Interestingly, in a subset of 943 patients with RCC, those treated with radical nephrectomy were significantly more likely to die from RCC compared with those treated with partial nephrectomy (hazard ratio 2.16; 95% CI 1.04–4.50; p=0.039) although this association only approached statistical significance in a multivariable analysis (hazard ratio 1.97; 95% CI 0.92–4.20; p=0.079). Conclusions Our results suggest that overall and cancer-specific survival is not compromised when partial nephrectomy is utilized for patients with 4-7cm renal cortical tumors. With the benefit of preserving renal function, our results support the use of partial nephrectomy whenever technically feasible for renal tumors up to 7cm.

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“…For example, Schachter et al reported that exophytic lesions were significantly more likely to be non–clear cell tumors when compared with central lesions ( p = 0.003), although no standardized definition of “exophytic” was provided [10]. In 123 patients undergoing laparoscopic partial nephrectomy, Venkatesh et al reported that only 55% of “highly exophytic” tumors were malignant, and of those, nearly all (96%) were low grade [11].…”

Section: Discussionmentioning

confidence: 99%

Anatomic Features of Enhancing Renal Masses Predict Malignant and High-Grade Pathology: A Preoperative Nomogram Using the RENAL Nephrometry Score

et al. 2011

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Background Counseling patients with enhancing renal mass currently occurs in the context of significant uncertainty regarding tumor pathology. Objective We evaluated whether radiographic features of renal masses could predict tumor pathology and developed a comprehensive nomogram to quantitate the likelihood of malignancy and high-grade pathology based on these features. Design, setting, and participants We retrospectively queried Fox Chase Cancer Center’s prospectively maintained database for consecutive renal masses where a Nephrometry score was available. Intervention All patients in the cohort underwent either partial or radical nephrectomy. Measurements The individual components of Nephrometry were compared with histology and grade of resected tumors. We used multiple logistic regression to develop nomograms predicting the malignancy of tumors and likelihood of high-grade disease among malignant tumors. Results and limitations Nephrometry score was available for 525 of 1750 renal masses. Nephrometry score correlated with both tumor grade (p < 0.0001) and histology (p < 0.0001), such that small endophytic nonhilar tumors were more likely to represent benign pathology. Conversely, large interpolar and hilar tumors more often represented high-grade cancers. The resulting nomogram from these data offers a useful tool for the preoperative prediction of tumor histology (area under the curve [AUC]: 0.76) and grade (AUC: 0.73). The model was subjected to out-of-sample cross-validation; however, lack of external validation is a limitation of the study. Conclusions The current study is the first to objectify the relationship between tumor anatomy and pathology. Using the Nephrometry score, we developed a tool to quantitate the preoperative likelihood of malignant and high-grade pathology of an enhancing renal mass.

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The impact of tumour location on the histological subtype of renal cortical tumours

Cited by 42 publications

References 39 publications

Preoperative predictors of malignancy and unfavorable pathology for clinical T1a tumors treated with partial nephrectomy: A multi-institutional analysis

Preoperative predictors of malignancy and unfavorable pathology for clinical T1a tumors treated with partial nephrectomy: A multi-institutional analysis

Partial Versus Radical Nephrectomy for 4 to 7 cm Renal Cortical Tumors

Anatomic Features of Enhancing Renal Masses Predict Malignant and High-Grade Pathology: A Preoperative Nomogram Using the RENAL Nephrometry Score

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