Skip to main content

Long-term oncological outcomes of cystic renal cell carcinoma according to the Bosniak classification

International Urology and Nephrology volume 51, pages 951–958 (2019)Cite this article

Abstract

Objectives

To evaluate the prognostic role of the Bosniak classification on the long-term oncological outcomes of cystic renal cell carcinomas.

Material and method

In a national multicentric retrospective study, we included patients treated surgically for localized cystic RCC from 2000 to 2010. Patients with a follow-up of less than 4 years, benign tumors, and ablative treatments were excluded. The primary outcome was disease-free survival.

Results

152 patients met the inclusion criteria: Bosniak II (6%), III (53%), IV (41%), with a median follow-up of 61 (12–179) months. Characteristics of the population and the tumors were [median, (min–max)] age 57 (25–84) years old, tumor size 43 mm (20–280), RENAL score 7 (4–12), PADUA score 8 (5–14). Treatments were 55% partial nephrectomy, 45% radical nephrectomy, 74% open surgery, and 26% laparoscopy. In pathological report, cystic RCC were mainly of low grade (1–2, 77%) and low stage (pT1, 81%). The two main histological subtypes were conventional (56%) and papillary (23%) RCC. Staging at presentation and histological characteristics were similar between Bosniak III and IV, except for high grade which was more common in Bosniak IV (12 vs 36%, p < 0.01). The Bosniak classification was not predictive of the recurrence, as 5- and 10-year disease-free survival were similar in Bosniak III and IV (92% vs 92% and 84% vs 83%, p = 0.60).

Conclusion

The Bosniak classification is predictive of the risk of malignancy but not of the oncological prognosis. Regardless of the initial Bosniak categories, almost all cystic RCCs were of low stage/grade and had low long-term recurrence rate.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158(1):1–10

    Article  CAS  PubMed  Google Scholar 

  2. Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924

    Article  PubMed  Google Scholar 

  3. Steven Campbell MD, Robert G, Uzzo MD, Mohamad E, Allaf MD, Eric B, Bass MD, Jeffrey MPH, Cadeddu A, Anthony Chang MD, Peter MD, Clark E, Philip MD, Pierorazio M, Brian MD, Davis J, Ithaar MD, PhD, Derweesh H, Leo Giambarresi MD, Debra PhD, Gervais A, Susie MD, Hu L, Brian MD, Lane R, Leibovich BC (2017) American Urological Association - Renal Mass and Localized Renal Cancer: AUA Guideline [Internet]. http://www.auanet.org/guidelines/renal-mass-and-localized-renal-cancer-new. Accessed 6 June 2018

  4. Warren KS, McFarlane J (2005) The Bosniak classification of renal cystic masses. BJU Int 95(7):939–942

    Article  PubMed  Google Scholar 

  5. Bosniak MA (1997) The use of the Bosniak classification system for renal cysts and cystic tumors. J Urol 157(5):1852–1853

    Article  CAS  PubMed  Google Scholar 

  6. Israel GM, Bosniak MA (2005) An update of the Bosniak renal cyst classification system. Urology 66(3):484–488

    Article  PubMed  Google Scholar 

  7. Israel GM, Bosniak MA (2003) Calcification in cystic renal masses: is it important in diagnosis? Radiology 226(1):47–52

    Article  PubMed  Google Scholar 

  8. Schoots IG, Zaccai K, Hunink MG, Verhagen PCMS (2017) Bosniak classification for complex renal cysts reevaluated: a systematic review. J Urol 198(1):12–21

    Article  PubMed  Google Scholar 

  9. Bielsa O, Lloreta J, Gelabert-Mas A (1998) Cystic renal cell carcinoma: pathological features, survival and implications for treatment. Br J Urol 82(1):16–20

    Article  CAS  PubMed  Google Scholar 

  10. Koga S, Nishikido M, Hayashi T, Matsuya F, Saito Y, Kanetake H (2000) Outcome of surgery in cystic renal cell carcinoma. Urology 56(1):67–70

    Article  CAS  PubMed  Google Scholar 

  11. Onishi T, Oishi Y, Goto H, Tomita M, Abe K, Sugaya S (2001) Cyst-associated renal cell carcinoma: clinicopathologic characteristics and evaluation of prognosis in 27 cases. Int J Urol Off J Jpn Urol Assoc 8(6):268–274

    CAS  Google Scholar 

  12. Nassir A, Jollimore J, Gupta R, Bell D, Norman R (2002) Multilocular cystic renal cell carcinoma: a series of 12 cases and review of the literature. Urology 60(3):421–427

    Article  PubMed  Google Scholar 

  13. Han K-R, Janzen NK, McWhorter VC, Kim HL, Pantuck AJ, Zisman A et al (2004) Cystic renal cell carcinoma: biology and clinical behavior. Urol Oncol 22(5):410–414

    Article  PubMed  Google Scholar 

  14. Webster WS, Thompson RH, Cheville JC, Lohse CM, Blute ML, Leibovich BC (2007) Surgical resection provides excellent outcomes for patients with cystic clear cell renal cell carcinoma. Urology 70(5):900–904 (discussion 904)

    Article  PubMed  Google Scholar 

  15. Donin NM, Mohan S, Pham H, Chandarana H, Doshi A, Deng F-M et al (2015) Clinicopathologic outcomes of cystic renal cell carcinoma. Clin Genitourin Cancer 13(1):67–70

    Article  PubMed  Google Scholar 

  16. Winters BR, Gore JL, Holt SK, Harper JD, Lin DW, Wright JL (2015) Cystic renal cell carcinoma carries an excellent prognosis regardless of tumor size. Urol Oncol 33(12):505.e9–505.e13

    Article  Google Scholar 

  17. Nouhaud FX, Bernhard JC, Bigot P, Khene ZE, Audenet F, Lang H et al (2018) Contemporary assessment of the correlation between Bosniak classification and histological characteristics of surgically removed atypical renal cysts (UroCCR-12 study). World J Urol 36(10):1643–1649

    Article  PubMed  Google Scholar 

  18. Moch H (2010) Cystic renal tumors: new entities and novel concepts. Adv Anat Pathol 17(3):209–214

    Article  PubMed  Google Scholar 

  19. Foshat M, Eyzaguirre E (2017) Acquired cystic disease-associated renal cell carcinoma: review of pathogenesis, morphology, ancillary tests, and clinical features. Arch Pathol Lab Med 141(4):600–606

    Article  CAS  PubMed  Google Scholar 

  20. Williamson SR, Halat S, Eble JN, Grignon DJ, Lopez-Beltran A, Montironi R et al (2012) Multilocular cystic renal cell carcinoma: similarities and differences in immunoprofile compared with clear cell renal cell carcinoma. Am J Surg Pathol 36(10):1425–1433

    Article  PubMed  Google Scholar 

  21. Huber J, Winkler A, Jakobi H, Bruckner T, Roth W, Hallscheidt P et al (2014) Preoperative decision making for renal cell carcinoma: cystic morphology in cross-sectional imaging might predict lower malignant potential. Urol Oncol 32(1):37.e1–37.e6

    Article  Google Scholar 

  22. Chandrasekar T, Ahmad AE, Fadaak K, Jhaveri K, Bhatt JR, Jewett MAS et al (2017) Natural history of complex renal cysts: clinical evidence supporting active surveillance. J Urol 199(3):633–640

    Article  PubMed  Google Scholar 

  23. Jhaveri K, Gupta P, Elmi A, Flor L, Moshonov H, Evans A et al (2013) Cystic renal cell carcinomas: do they grow, metastasize, or recur? Am J Roentgenol 201(2):W292–W296

    Article  Google Scholar 

  24. Spaliviero M, Herts BR, Magi-Galluzzi C, Xu M, Desai MM, Kaouk JH et al (2005) Laparoscopic partial nephrectomy for cystic masses. J Urol 174(2):614–619

    Article  PubMed  Google Scholar 

  25. Pradere B, Peyronnet B, Delporte G, Manach Q, Khene Z-E, Moulin M et al (2018) Intraoperative cyst rupture at partial nephrectomy of cystic renal masses: does it increase the risk of recurrence? J Urol 200(6):1200–1206

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, 13005, Marseille, France

    R. Boissier & S. Chkir

  2. Urology Department, Bichat—Claude-Bernard, Paris, France

    I. Ouzaid

  3. Urology Department, Rouen University Hospital, Rouen, France

    F. X. Nouhaud & A. Giwerc

  4. Urology Department, Rennes University Hospital, Rennes, France

    Z. Khene & K. Bensalah

  5. Urology Department, Georges Pompidou University Hospital, Paris, France

    C. Dariane & A. Mejean

  6. Urology Department, Angers University Hospital, Angers, France

    S. Chelly & P. Bigot

  7. Urology Department, Bordeaux University Hospital, Bordeaux, France

    C. Allenet & J. C. Bernhard

  8. Urology Department, Grenoble University Hospital, La Tronche, France

    J. B. Lefrancq & J. A. Long

  9. Urology Department, Medipole, Cabestany, France

    P. Gimel

  10. Urology Department, Saint-Joseph Hospital, Marseille, France

    T. Bodin

  11. Pathology Department, Rennes University Hospital, Rennes, France

    N. Rioux-Leclercq

  12. Radiology Department, Georges Pompidou University Hospital, Paris, France

    J. M. Correas

  13. Oncology Department, Gustave Roussy Institute, Paris, France

    L. Albiges

  14. Urology Department, Clinique Jules Verne, Nantes, France

    J. F. Hetet

Authors
  1. R. Boissier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Ouzaid
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. X. Nouhaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Z. Khene
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Dariane
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Chkir
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Chelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Giwerc
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. Allenet
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. J. B. Lefrancq
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. P. Gimel
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. T. Bodin
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. N. Rioux-Leclercq
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. J. M. Correas
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. L. Albiges
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. J. F. Hetet
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. P. Bigot
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. J. C. Bernhard
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. J. A. Long
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. A. Mejean
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. K. Bensalah
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the AFU Committee of Urological Oncology

Contributions

RB had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Protocol/project development: Boissier, Bensalah. Data collection or management: Chkir. Chelly, Dariane, Khene, Giwerc, Allenet, Lefrancq, Gimel, Hetet. Data analysis: Boissier, Bensalah. Manuscript writing/editing: Boissier. Other (please specify briefly using 1 to 5 words): Critical revision of the manuscript for important intellectual content: Nouhaud, Bigot, Bernhard, Long, Gimel, Bodin, Ouzaid, Rioux-Leclercq, Correas, Albigès, Mejean.

Corresponding author

Correspondence to R. Boissier.

Ethics declarations

Conflict of interest

Authors reported no conflict of interest regarding this study.

Research involving human participants and/or animals

All included patients had locally signed a consent for the use of clinical and follow-up data for research purposes. The study was approved by the ethics committee of Association Francaise d’Urologie.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Boissier, R., Ouzaid, I., Nouhaud, F.X. et al. Long-term oncological outcomes of cystic renal cell carcinoma according to the Bosniak classification. Int Urol Nephrol 51, 951–958 (2019). https://doi.org/10.1007/s11255-019-02085-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-019-02085-6

Keywords

  • Renal cell carcinoma
  • Complex renal cyst
  • Bosniak