Abstract
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 immediate 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.
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References
Abou Youssif T, Tanguay S (2009) Natural history and management of small renal masses. Curr Oncol 16(Suppl 1):S2–S7
Abou Youssif T, Kassouf W, Steinberg J, Aprikian AG, Laplante MP, Tanguay S (2007) Active surveillance for selected patients with renal masses: updated results with long-term follow-up. Cancer 110(5):1010–1014
Abouassaly R, Lane BR, Novick AC (2008) Active surveillance of renal masses in elderly patients. J Urol 180(2):505–508
Beisland C, Hjelle KM, Reisaeter LA, Bostad L (2009) Observation should be considered as an alternative in management of renal masses in older and comorbid patients. Eur Urol 55(6):1419–1427
Bosniak MA, Birnbaum BA, Krinsky GA, Waisman J (1995) Small renal parenchymal neoplasms: further observations on growth. Radiology 197(3):589–597
Cary KC, Sundaram CP (2009) Watchful waiting in the treatment of the small renal mass. Indian J Urol 25(4):489–493
Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG (2006) The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 175(2):425–431
Crispen PL, Viterbo R, Boorjian SA, Greenberg RE, Chen DY, Uzzo RG (2009) Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance. Cancer 115(13):2844–2852
Fernando HS, Duvuru S, Hawkyard SJ (2007) Conservative management of renal masses in the elderly: our experience. Int Urol Nephrol 39(1):203–207
Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6(7):655–663
Fujimoto N, Sugita A, Terasawa Y, Kato M (1995) Observation the growth rate of renal carcinoma. Int J Urol 2(2):71–76
Guinan P, Sobin LH, Algaba F, Badellino F, Kameyama S, MacLennan G, Novick A (1997) TNM staging of renal cell carcinoma: workgroup no. 3. Union International Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer 1; 80(5):992–993
Hafez KS, Fergany AF, Novick AC (1999) Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol 162(6):1930–1933
Hock LM, Lynch J, Balaji KC (2002) Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end results program data. J Urol 167(1):57–60
Jewett MA, Zuniga A (2008) Renal tumor natural history: the rationale and role for active surveillance. Urol Clin North Am 35(4):627–634
Kato M, Suzuki T, Suzuki Y, Terasawa Y, Sasano H, Arai Y (2004) Natural history of small renal cell carcinoma: evaluation of growth rate, histological grade, cell proliferation and apoptosis. J Urol 172(3):863–866
Kouba E, Smith A, McRackan D, Wallen EM, Pruthi RS (2007) Watchful waiting for solid renal masses: insight into the natural history and results of delayed intervention. J Urol 177(2):466–470
Kovacs G, Akhtar M, Beckwith BJ, Bugert P, Cooper CS, Delahunt B, Eble JN, Fleming S, Ljungberg B, Medeiros LJ et al (1997) The Heidelberg classification of renal cell tumors. J Pathol 183(2):131–133
Kunkle DA, Egleston BL, Uzzo RG (2008) Excise, ablate or observe: the small renal mass dilemma—a meta-analysis and review. J Urol 179(4):1227–1233
Lamb GW, Bromwich EJ, Vasey P, Aitchison M (2004) Management of renal masses in patients medically unstable for nephrectomy—natural history, complications, and outcomes. Urology 64(5):909–913
Lee JY, Kim CK, Choi D, Park BK (2008) Volume doubling time and growth rate of renal cell carcinoma determined by helical CT: a single-institution experience. Eur Radiol 18(4):731–737
Mattar K, Jewett MA (2008) Watchful waiting for small renal masses. Curr Urol Rep 9(1):22–25
Oda T, Miyao N, Takahashi A, Yanase M, Masumori N, Itoh N, Tamakawa M, Tsukamoto T (2001) Growth rates of primary and metastatic lesions of renal cell carcinoma. Int J Urol 8(9):473–477
Rendon RA, Jewett MA (2006) Expectant management for the treatment of small renal masses. Urol Oncol 24(1):62–67
Rendon RA, Stanietzky N, Panzarella T, Robinette M, Klotz LH, Thurston W, Jewett MA (2000) The natural history of small renal masses. J Urol 164(4):1143–1147
Siu W, Hafez KS, Johnston WK 3rd, Wolf JS Jr (2007) Growth rates of renal cell carcinoma and oncocytoma under surveillance are similar. Urol Oncol 25(2):115–119
Van Poppel H, Joniau S (2007) Is surveillance an option for the treatment of small renal masses? Eur Urol 52(5):1323–1330
Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA (2004) The natural history of incidentally detected small renal masses. Cancer 15; 100(4):738–745
Wehle MJ, Thiel DD, Petrou SP, Young PR, Frank I, Karsteadt N (2004) Conservative management of incidental contrast-enhancing renal masses as safe alternative to invasive therapy. Urology 64(1):49–52
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Xue-Song Li and Lin Yao contributed equally to this article.
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Li, XS., Yao, L., Gong, K. et al. Growth pattern of renal cell carcinoma (RCC) in patients with delayed surgical intervention. J Cancer Res Clin Oncol 138, 269–274 (2012). https://doi.org/10.1007/s00432-011-1083-0
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DOI: https://doi.org/10.1007/s00432-011-1083-0