CU 07. Growth pattern of renal cell carcinoma (RCC) in patientswith delayed surgical intervention
Clinical Urology

CU 07. Growth pattern of renal cell carcinoma (RCC) in patientswith delayed surgical intervention

Xue-Song Li, Lin Yao, Kan Gong, Wei Yu, Qun He, Li- Qun Zhou, Zhi-Song He

Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer Center, No. 8 Xishiku St, Xicheng District, Beijing 100034, China

Purpose: Few studies have evaluated the growth pattern of renal cell carcinoma (RCC) in patients with delayed treatment. This report investigated the growth rate and stage progression of incidentally discovered RCC following a long period of active surveillance.

Methods: Thirty-two patients who did not receive imme diate surgical treatment for renal solid masses that later proved to be RCC were reviewed retrospectively. Annual tumor growth rates were calculated according to changes in the maximal diameter on CT or MRI. Clinical and pathological characteristics associated with tumor growth rate and stage progression were analyzed.

Results: The median tumor size grow from 2.14 (range, 0.30- 6.70) cm to 4.33 (range, 1.40-8.80) cm after a median 46.0 months observation period. The average tumor growth rate was 0.80 (range, 0.16-3.80) cm/year. Clear cell carcinoma (0.86 cm/ year) tended to grow faster than papillary cell carcinoma (0.28 cm/year) (P=0.066). The mean growth rate of grade 2 tumors (0.88 cm/year) was faster than that of grade 1 tumors (0.36 cm/year) (P=0.041). Thirteen tumors (40.6%) were upstaged at a median 48 months after initial presentation. Cox regression analysis revealed initial tumor size as the only risk factor for upstaging (P=0.018). No local and systemic recurrences were noted in our cohort after the intervention at a median of 47 (range 6-248) months of follow-up.

Conclusions: RCCs were found to be slow growing in a group of untreated renal cell carcinoma patients. However, some tumors progressed in stage under observation. The growth rate of RCC tended to correlate with histologic grade and histologic subtype.

Key words

Active surveillance; delayed intervention; growth rate; kidney neoplasms; natural history

DOI: 10.3978/j.issn.2223-4683.2012.s021

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