Tumor Size is a Determinant of the Rate of Stage T1 Renal Cell Cancer Synchronous Metastasis
2009; Lippincott Williams & Wilkins; Volume: 182; Issue: 4 Linguagem: Inglês
10.1016/j.juro.2009.06.018
ISSN1527-3792
AutoresGiovanni Lughezzani, Claudio Jeldres, Hendrik Isbarn, Paul Perrotte, Shahrokh F. Shariat, Maxine Sun, Hugues Widmer, Philippe Arjane, François Péloquin, Daniel Pharand, Jean‐Jacques Patard, Markus Graefen, Francesco Montorsi, Pierre I. Karakiewicz,
Tópico(s)Renal and related cancers
ResumoNo AccessJournal of UrologyAdult Urology1 Oct 2009Tumor Size is a Determinant of the Rate of Stage T1 Renal Cell Cancer Synchronous Metastasisis accompanied byIncreased Tissue Factor Expression and Poor Nephroblastoma Prognosis Giovanni Lughezzani, Claudio Jeldres, Hendrik Isbarn, Paul Perrotte, Shahrokh F. Shariat, Maxine Sun, Hugues Widmer, Philippe Arjane, Francois Peloquin, Daniel Pharand, Jean-Jacques Patard, Markus Graefen, Francesco Montorsi, and Pierre I. Karakiewicz Giovanni LughezzaniGiovanni Lughezzani Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada Department of Urology, Vita-Salute San Raffaele University, Milan, Italy , Claudio JeldresClaudio Jeldres Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada , Hendrik IsbarnHendrik Isbarn Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada Martini-clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany , Paul PerrottePaul Perrotte Department of Urology, University of Montreal, Montreal, Quebec, Canada , Shahrokh F. ShariatShahrokh F. Shariat Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada , Maxine SunMaxine Sun Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada , Hugues WidmerHugues Widmer Department of Urology, University of Montreal, Montreal, Quebec, Canada , Philippe ArjanePhilippe Arjane Department of Urology, University of Montreal, Montreal, Quebec, Canada , Francois PeloquinFrancois Peloquin Department of Urology, University of Montreal, Montreal, Quebec, Canada , Daniel PharandDaniel Pharand Department of Urology, University of Montreal, Montreal, Quebec, Canada , Jean-Jacques PatardJean-Jacques Patard Department of Urology, Rennes University Hospital, Rennes, France , Markus GraefenMarkus Graefen Martini-clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany , Francesco MontorsiFrancesco Montorsi Department of Urology, Vita-Salute San Raffaele University, Milan, Italy , and Pierre I. KarakiewiczPierre I. Karakiewicz Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada View All Author Informationhttps://doi.org/10.1016/j.juro.2009.06.018AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: A recent multi-institutional analysis of 995 patients treated for renal cell cancer questioned the relationship between tumor size and the synchronous metastasis rate. We revisited the hypothesis that metastatic potential is unrelated to tumor size. Materials and Methods: We tested the relationship between tumor size and synchronous metastasis in 22,204 patients with T1a and T1b renal cell cancer diagnosed and/or treated with nephrectomy for clear cell, papillary or chromophobe histological subtypes in 1 of 9 Surveillance, Epidemiology and End Results registries between 1988 and 2004. Results: In the study population the synchronous metastasis rate was 9.6%, including 5.6% vs 14.2% for T1a vs T1b. Stratification by 1 cm tumor size intervals revealed that the rate increased with increasing tumor size, that is 4.8% at 1.0 cm or less, 4.2% at 1.1 to 2.0 cm, 4.9% at 2.1 to 3.0 cm, 7.1% at 3.1 to 4.0 cm, 12.1% at 4.1 to 5.0 cm, 13.3% at 5.1 to 6.0 cm and 18.4% 6.1 to 7.0 cm (chi-square trend p <0.001). Cubic spline analysis showed that tumor size was virtually linearly related to the synchronous metastasis rate. Stratification by histological subtype in patients treated with nephrectomy revealed that clear cell renal cell cancer was most frequently associated with synchronous metastasis. Finally, tumor size was an independent predictor of synchronous metastasis in multivariate regression models adjusted for age, gender, histological subtype and year of diagnosis quartiles. Conclusions: Our study confirms that tumor size is an important determinant of the likelihood of synchronous metastasis in patients with T1a and T1b renal cell cancer. The synchronous metastasis rate directly increases with increasing tumor size. Even patients with small renal masses are at risk for synchronous metastasis and patients with clear cell renal cell cancer are at highest risk. References 1 : The significance of tumor diameter in renal cell carcinoma. Urologe A1992; 31: 70. Google Scholar 2 : Radical nephrectomy for renal cell carcinoma 30 mm. or less: long-term follow results. J Urol1996; 155: 1196. Link, Google Scholar 3 : Are small renal tumors harmless?: Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol2006; 176: 896. Link, Google Scholar 4 : Outcomes following partial nephrectomy by tumor size. J Urol2008; 180: 1912. 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Google Scholar © 2009 by American Urological AssociationFiguresReferencesRelatedDetailsRelated articlesJournal of Urology17 Aug 2009Increased Tissue Factor Expression and Poor Nephroblastoma Prognosis Volume 182Issue 4October 2009Page: 1287-1293 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordscarcinomarenal cellneoplasm metastasisneoplasm stagingnephrectomykidneyMetricsAuthor Information Giovanni Lughezzani Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada Department of Urology, Vita-Salute San Raffaele University, Milan, Italy More articles by this author Claudio Jeldres Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author Hendrik Isbarn Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada Martini-clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany More articles by this author Paul Perrotte Department of Urology, University of Montreal, Montreal, Quebec, Canada More articles by this author Shahrokh F. Shariat Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author Maxine Sun Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author Hugues Widmer Department of Urology, University of Montreal, Montreal, Quebec, Canada More articles by this author Philippe Arjane Department of Urology, University of Montreal, Montreal, Quebec, Canada More articles by this author Francois Peloquin Department of Urology, University of Montreal, Montreal, Quebec, Canada More articles by this author Daniel Pharand Department of Urology, University of Montreal, Montreal, Quebec, Canada More articles by this author Jean-Jacques Patard Department of Urology, Rennes University Hospital, Rennes, France More articles by this author Markus Graefen Martini-clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany More articles by this author Francesco Montorsi Department of Urology, Vita-Salute San Raffaele University, Milan, Italy More articles by this author Pierre I. Karakiewicz Cancer Prognosis and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada More articles by this author Expand All Advertisement PDF downloadLoading ...
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