Background: Small renal masses (SRMs) are defined as contrast-enhanced masses with a diameter of ≤4 cm, usually consistent with clinical stage T1a renal cell carcinoma (RCC). This study aimed to explore the histopathological features of a contemporary series of SRMs and investigate parameters that could predict their pathological nature, metastatic potential, and recurrence potential.
Materials and methods: Small renal masses were identified in 166 of 427 patients who underwent surgery for suspected RCC. The radical nephrectomy/partial nephrectomy ratio was 1:44, and autotransplantation was performed in a single case. Variables associated with metastatic recurrence of SRM were analyzed using χ2 and logistic regression models.
Results: Renal cell carcinoma was confirmed in 86% (n = 143) of cases, whereas benign tumors were present in 14% (n = 23) of cases. Seventeen percent of the RCC cases were high-grade (Fuhrman G3-4). Among SRMs with a diameter of >2 cm, 71% were malignant. The mean ± standard deviation diameter of the removed SRMs was 28 ± 12 mm, significantly higher in the malignant SRMs group (31 ± 8 vs. 24 ± 9 mm) (p = 0.005). During follow-up, local recurrence was identified in 4 patients versus new distant metastasis in 11 patients. Metastatic lesions were detected in the lungs (1.8%), bone (1.2%), distant (1.9%) and regional lymph nodes (1.2%), liver (0.6%), and multiple organs (2.4%). Patients with malignant SRMs were significantly older than those with benign tumors (p = 0.036). The multivariate analysis identified tumor size, Fuhrman grade, stage, nodal and distant metastasis status, tumor localization, and treatment modality as characteristics significant for tumor recurrence.
Conclusions: The majority of treated neoplasms were malignant, but their incidence was low among SRMs with a diameter of <2 cm. Our results emphasized the importance of histopathological features and treatment modalities in predicting malignant recurrence.
Acknowledgments
None.
Statement of ethics
This study was approved by the Clinical Center University of Sarajevo Ethics Committee (No. 03-02-4932). All data were collected after obtaining informed consent from all participants. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflict of interest statement
No conflict of interest has been declared by the author.
Funding source
None.
Author contributions
SB, JA: Concept and study design;
BH, JA, SB: Methods and experimental work;
SB, DA, JA, NŠB: Results analysis and conclusions;
JA, BH, SB: Manuscript preparation;
NŠB, BH, JA, DA: Others.
Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
| [1] |
Finelli A, Ismaila N, Russo P. Management of small renal masses: American Society of Clinical Oncology clinical practice guideline summary. J Oncol Pract 2017; 13(4):276-278.
|
| [2] |
Campbell S, Uzzo RG, Allaf ME, et al. Renal mass and localized renal cancer: AUA guideline. J Urol 2017; 198(3):520-529.
|
| [3] |
Özcan MF, Altınova S, Atan A. Treatment approaches to small renal masses in patients of advanced age (≥75 years). Turk J Urol 2018; 44(4):281-286.
|
| [4] |
Barbaric ZL. Chapter 10: Renal neoplasms. In: Principles of Genitourinary Radiology. 2nd ed. New York, NY: Thieme Medical Publishers; 1994:151-201.
|
| [5] |
Eble JN, Sauter G, Epstein JI, Sesterhenn IA. Chapter 1: Tumors of the kidney. In: World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. 3rd ed. Lyon, France: IARC Press; 2004:9-87.
|
| [6] |
Elkoushy MA, Andonian S. Surgical, radiologic, and endoscopic anatomy of the kidney and ureter. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:967-978.
|
| [7] |
Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982; 6(7):655-663.
|
| [8] |
Nguyen MM, Gill IS. Effect of renal cancer size on the prevalence of metastasis at diagnosis and mortality. J Urol 2009; 181(3):1020-1027 discussion 1027.
|
| [9] |
Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: An analysis of pathological features related to tumor size. J Urol 2003; 170(6 Pt1):2217-2220.
|
| [10] |
Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA. The natural history of incidentally detected small renal masses. Cancer 2004; 100(4):738-745.
|
| [11] |
Pierorazio PM, Johnson MH, Ball MW, et al. Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: The DISSRM registry. Eur Urol 2015; 68(3):408-415.
|
| [12] |
Ristau BT, Kutikov A, Uzzo RG, Smaldone MC. Active surveillance for small renal masses: When less is more. Eur Urol Focus 2016; 2(6):660-668.
|
| [13] |
Ha SC, Zlomke HA, Cost N, Wilson S. The past, present, and future in management of small renal masses. J Oncol 2015;2015:364807.
|
| [14] |
Marra G, Oderda M, Allasia M, Munegato S, Joniau S, Gontero P. A review on the management of small renal masses: Active surveillance versus surgery. Anticancer Agents Med Chem 2018; 18(7):940-950.
|
| [15] |
Patel HD, Pierorazio PM, Johnson MH, et al. Renal functional outcomes after surgery, ablation, and active surveillance of localized renal tumors: A systematic review and meta-analysis. Clin J Am Soc Nephrol 2017; 12(7):1057-1069.
|
| [16] |
Choi YS, Park YH, Kim YJ, Kang SH, Byun SS, Hong SH. Predictive factors for the development of chronic renal insufficiency after renal surgery: A multicenter study. Int Urol Nephrol 2014; 46(4):681-686.
|
| [17] |
Scosyrev E, Messing EM, Sylvester R, Campbell S, Van Poppel H. Renal function after nephron-sparing surgery versus radical nephrectomy: Results from EORTC randomized trial 30904. Eur Urol 2014; 65(2):372-377.
|
| [18] |
Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology guidelines on renal cell carcinoma: The 2019 update. Eur Urol 2019; 75(5):799-810.
|
| [19] |
Crestani A, Rossanese M, Calandriello M, Sioletic S, Giannarini G, Ficarra V. Introduction to small renal tumours and prognostic indicators. Int J Surg 2016;36(Pt C):495-503.
|
| [20] |
DeRoche T, Walker E, Magi-Galluzzi C, Zhou M. Pathologic characteristics of solitary small renal masses: Can they be predicted by preoperative clinical parameters? Am J Clin Pathol 2008; 130(4):560-564.
|
| [21] |
Verhoest G, Veillard D, Guillé F, et al. Relationship between age at diagnosis and clinicopathologic features of renal cell carcinoma. Eur Urol 2007; 51(5):1298-1304 discussion 1304-1305.
|
| [22] |
Pahernik S, Ziegler S, Roos F, Melchior SW, Thüroff JW. Small renal tumors: Correlation of clinical and pathological features with tumor size. J Urol 2007; 178(2):414-417 discussion 416-417.
|
| [23] |
Zisman A, Patard JJ, Raz O, et al. Sex, age, and surgeon decision on nephron-sparing surgery are independent predictors of renal masses with benign histologic findings-A multicenter survey. Urology 2010; 76(3):541-546.
|
| [24] |
Violette P, Abourbih S, Szymanski KM, et al. Solitary solid renal mass: Can we predict malignancy? BJU Int 2012; 110(11 Pt B):E548-E552.
|
| [25] |
Raj GV, Thompson RH, Leibovich BC, Blute ML, Russo P, Kattan MW. Preoperative nomogram predicting 12-year probability of metastatic renal cancer. J Urol 2008; 179(6):2146-2151 discussion 2151.
|
| [26] |
Bhindi B, Thompson RH, Lohse CM, et al. The probability of aggressive versus indolent histology based on renal tumor size: Implications for surveillance and treatment. Eur Urol 2018; 74(4):489-497.
|
| [27] |
Thompson RH, Kurta JM, Kaag M, et al. Tumor size is associated with malignant potential in renal cell carcinoma cases. J Urol 2009; 181(5):2033-2036.
|
PDF
(146KB)
