The behavior of renal cell carcinoma: sex, lies and tumor size.

摘要

The size of renal cell carcinoma has frequently been associated with prognosis. In this issue of The Journal Klatte et al (page 1719) report on 1,208 patients with tumors 4.0 cm or smaller who were treated with nephrectomyat 5 international centers. Of the tumors 88% were renal cell carcinoma. Interestingly the incidence of meta-static disease was found to be similar in 1, 2 and 3 cm tumors, and 3% of patients with initial localized disease died of renal cell carcinoma. As new forms of less invasive treatment for renal tumors such as radio frequency ablation and cryotherapy emerge, the natural history of these small tumors remains important. Factors associated with metastatic disease included poor performance status, symptoms, higher T stage and higher grade. It was interesting that patients who presented with metastatic disease had a median survival time of 45 months. One and 5-year survival rates were 76% and 42%, respectively, which are considerably better than expected in patients with renal cell carcinoma with larger tumors. There were some limitations to this study including a lack of pathological review by a single pathologist. How often was there peripelvic fat involvement or microvascularinvasion? There was no standardization of pre-operative imaging or postoperative surveillance. How many patients had formal nodal dissections and how many did not? How often was there careful pathological review of regional lymph nodes? In spite of some of these deficiencies it is apparent that small renal tumors, even in the 1 to 2 cm range, have a small but real risk of metastasis.