Department of Urology, Mount Sinai School of Medicine, New York, NY.
Department of Urology, Johns Hopkins Medical Center, Baltimore, MD, USA.
Study Type - Prognosis (case series) Level of Evidence 4.
What's known on the subject? and What does the study add? There is a small cohort of patients who have small renal masses with metastatic potential, yet risk factors for having this more aggressive disease are largely unknown. In a large sampling of the US population, older patients and men were more likely to have small renal masses at an advanced stage.
To assess the prevalence metastatic and locally advanced renal cell carcinoma (RCC) in the US population with small renal masses (SRMs). To determine what patient and tumour characteristics predict having more advanced SRMs.
Using the Surveillance, Epidemiology and End Results (SEER) registry, we identified 14 962 patients who were diagnosed between 1988 and 2007 with RCC ≤ 3 cm in size. Patients were separated by stage into those with metastatic, locally advanced and localized disease. Differences in baseline characteristics between patients in these three groups were assessed. After controlling for age, sex, grade, tumour size and year of surgery, a logistic regression analysis was performed to determine the likelihood of having non-localized disease.
In the SEER cohort, 13 574 (90.7%) patients with RCC ≤ 3 cm in size were diagnosed with localized disease, 938 (6.3%) patients had invasion beyond the kidney into regional lymph nodes or nearby organs, and 450 (3.0%) patients had distant metastasis. Patients with metastasis were older (65.9 years) compared to those with localized disease (59.5 years) (P < 0.001). Independent preoperative predictors of having more aggressive disease at diagnosis (locally advanced/metastatic) included older age, particularly age >70 years (odds ratio, OR, 2.42; 95% confidence interval, CI, 2.03-2.88), male sex (OR, 1.50; 95% CI, 1.33-1.70) and tumour size >2.5 (OR, 1.41; 95% CI, 1.25-1.58).
A small subset (3%) of patients in the USA with RCC ≤ 3 cm in size have distant metastasis. Older patients, men and those with tumours 2.5-3.0 cm in size have a greater probability of presenting with non-localized disease . Clinicians should be aware that there is a risk of metastases in patients with SRMs and also familiarize themselves with the characteristics associated with advanced disease.
Written by:
Kates M, Korets R, Sadeghi N, Pierorazio PM, McKiernan JM. Are you the author?
Reference: BJU Int. 2011 Sep 20. doi: Epub ahead of print.
doi: 10.1111/j.1464-410X.2011.10553.x
PubMed Abstract
PMID: 21933329
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