Tumor necrosis is a strong predictor for recurrence in patients with pathological T1a renal cell carcinoma

Abstract

Patients with pT1aN0M0 renal cell carcinoma (RCC) generally have good prognosis, and recurrence is rare. However, metastasis develops postoperatively in a small number of patients with pT1aN0M0 RCC. The present study was undertaken to identify predictors for recurrence in patients with pT1aN0M0 RCC. We reviewed the clinicopathological factors of 133 patients with pT1aN0M0 RCC who underwent radical or partial nephrectomy at the Department of Urology, National Defense Medical College (Saitama, Japan). Clinicopathological factors, including age, gender, tumor size, histological subtype, tumor grade, microvascular invasion, histological tumor necrosis, C-reactive protein levels and performance status were reviewed. These factors were compared between patients with and without postoperative recurrence. Recurrence-free survival (RFS) and cause-specific survival (CSS) rates were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to determine independent factors predicting recurrence in patients with pT1aN0M0 RCC. The 5-year RFS and CSS rates were 97.2 and 99.1%, respectively. When clinicopathological factors were compared between patients with and without recurrence, tumor size (P=0.0390) and percentage of tumor necrosis (P<0.0001) were significantly different between groups. All patients with recurrence had primary lesions ≥3 cm. By univariate analysis, tumor size (P=0.0379) and the presence of tumor necrosis (P=0.0319) were significant predictors for recurrence; tumor necrosis was also an independent predictor for recurrence (P=0.0143). In patients with pT1b tumors ≤5 cm (recurrence rate, 16.8%; n=48), the percentage of tumor necrosis was significantly higher in patients with recurrence compared with those without (P=0.0261). This suggests that tumor necrosis may be an important predictor for recurrence in small RCCs. Although recurrence is rare in pT1a RCC, the presence of tumor necrosis may be an important predictor for recurrence. Particularly, patients presenting with pT1a RCC with histological tumor necrosis should undergo careful follow-up.

Assessment of apparent diffusion coefficient value as prognostic factor for renal cell carcinoma aggressiveness

“…The presence of tumor necrosis is a well-established independent indicator of a poor prognosis for RCC, and presence of necrosis results in higher ADC values [18,19]. In our study, there was a statistically significant positive correlation between the ADC values and tumor necrosis.…”

“…So, further studies with larger patient populations are warranted [18]. The number of cells is a crucial indicator of tumor grade [19]. It has been suggested that the decreased ADC value may be due to their increased cellularity, larger nuclei with more abundant macromolecular proteins, and less extracellular space [20,21].…”

Preoperative albumin to globulin ratio predicts survival in clear cell renal cell carcinoma patients

“…TNM stage was assigned according to the 2010 AJCC TNM classification [ 3 ]. Tumor necrosis was defined as microscopic coagulative necrosis [ 26 ]. Lymphovascular invasion was defined as tumor cell invasion of blood vessels or lymphatic vessels, but not the underlying muscular walls [ 27 ].…”

Small renal masses in the era of personalized medicine: Tumor heterogeneity, growth kinetics, and risk of metastasis

“…They analyzed data from 133 patients who underwent RN or PN, comparing the clinico-pathological characteristics of patients with or without recurrence. They found that tumor size and the percentage of tumor necrosis significantly differed between the 2 groups and were confirmed as predictors of recurrence at univariate analysis [49]. Based on these data, the presence of necrosis should be considered to optimize the follow-up of patients with SRMs, although these findings should be confirmed in prospective trials.…”