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Risk of metastasis for T1a renal cell carcinoma

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Abstract

Introduction

While active surveillance for small renal mass is gaining acceptance, controversy still continues on true metastatic potential of small renal cell carcinoma (RCC). Thus, we investigated the risks of synchronous/metachronous metastases and their potential predictors among T1a RCC patients who underwent surgical treatment.

Methods

We reviewed data from 2114 patients who received radical or partial nephrectomy for small renal tumor (≤4 cm) from 1990 to 2013. For our study, patients were stratified into four different groups according to tumor size (group 1: 0–1.0 cm, group 2: 1.1–2.0 cm, group 3: 2.1–3.0 cm, group 4: 3.1–4.0 cm). Univariate and multivariate analyses were performed to analyze metastatic potentials according to tumor size and identify useful predictors of metastases.

Results

Among 1913 T1a RCC patients, there were low but nonnegligible rates of metastases (group 2: 1.1 %, group 3: 3.3 %, group 4: 6.0 %, respectively). Kaplan–Meier analysis showed significant differences in metastasis-free survivals between groups (p < 0.001). A linear positive association was observed between tumor size and metastatic rate (p < 0.001). Diabetic T1a RCC patients showed significantly inferior metastasis-free survival than nondiabetic counterparts (p = 0.003). Multivariate analysis revealed that tumor size and history of diabetes mellitus were independently associated with metastasis in T1a RCC.

Conclusions

As T1a RCCs present low but nonnegligible risk of metastasis, patients with small renal mass should be counseled on such risk when offered active surveillance. Larger tumor size and history of diabetes mellitus may be associated with higher risk of metastasis in T1a RCC.

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Abbreviations

RCC:

Renal cell carcinoma

CT:

Computed tomography

SRMs:

Small renal masses

DM:

Diabetes mellitus

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Author contributions

Conception and design of study: Hakmin Lee, Sung Kyu Hong. Acquisition of data: Hakmin Lee, Jung Keun Lee, Kwangmo Kim, Seok-Soo Byun, Sang Eun Lee, Cheol Kwak, Hyeon Hoe Kim. Statistical analysis and interpretation of data: Hakmin Lee, Jung Keun Lee, Kwangmo Kim, Seok-Soo Byun, Sang Eun Lee, Cheol Kwak, Hyeon Hoe Kim. Draft of manuscript: Hakmin Lee, Sung Kyu Hong. Revise of manuscript with intellectual criticism: Hakmin Lee, Sung Kyu Hong, Seok-Soo Byun, Sang Eun Lee. Final approval of the version to be published: approved by all authors.

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Authors and Affiliations

  1. Department of Urology, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam-si, Gyunggi-do, 463-707, Korea

    Hakmin Lee, Jung Keun Lee, Kwangmo Kim, Seok-Soo Byun, Sang Eun Lee & Sung Kyu Hong

  2. Department of Urology, Seoul National University Hospital, Seoul, Korea

    Cheol Kwak & Hyeon Hoe Kim

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  1. Hakmin Lee
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  2. Jung Keun Lee
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  3. Kwangmo Kim
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  6. Seok-Soo Byun
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  7. Sang Eun Lee
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Correspondence to Sung Kyu Hong.

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Competing interest

All authors have no financial interests with other people or organizations.

Ethical standards

The creation and retrospective review of our database was approved by the Institutional Review Board and therefore conforms to the ethical standards laid down in the 1964 Helsinki Declaration and its later amendments. No information with the potential to disclose patient identities was included.

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Cite this article

Lee, H., Lee, J.K., Kim, K. et al. Risk of metastasis for T1a renal cell carcinoma. World J Urol 34, 553–559 (2016). https://doi.org/10.1007/s00345-015-1659-4

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  • DOI: https://doi.org/10.1007/s00345-015-1659-4

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