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Metastatic potential of a renal mass according to original tumour size at presentation
Author(s) -
Umbreit Eric C.,
Shimko Mark S.,
Childs M. Adam,
Lohse Christine M.,
Cheville John C.,
Leibovich Bradley C.,
Blute Michael L.,
Thompson R. Houston
Publication year - 2012
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2011.10184.x
Subject(s) - medicine , renal cell carcinoma , hazard ratio , confidence interval , proportional hazards model , renal mass , metastasis , oncology , urology , cancer , nephrectomy , kidney
Study Type – Prognosis (case series) Level of Evidence 4 OBJECTIVE • To determine the metastatic potential of renal masses based on original tumour size. MATERIALS AND METHODS • We identified 2651 patients who had undergone surgical resection for a unilateral, sporadic renal tumour between 1990 and 2006. • Associations of tumour size with synchronous metastasis at presentation [M1 renal cell carcinoma (RCC)] and development of metastases, death from RCC, and death from any cause after surgery were evaluated using logistic and Cox proportional hazards regression. RESULTS • Of the 2651 patients studied, 182 (6.9%) presented with M1 RCC. Tumour size was significantly greater in patients with M1 RCC than in patients with M0 RCC (a median size of 10 vs 4.5 cm; P < 0.001). Only 1 of the 629 patients (0.2%) with a tumour <3 cm had M1 RCC and that tumour was 2.5 cm. The risk of M1 RCC increased from 1.1% for patients with tumours 3–3.9 cm to 16.5% for patients with tumours ≥7 cm. • Of the 2124 patients with M0 RCC, 430 developed distant metastases at a median (range) of 1.4 (0.1–16.2) years after surgery. Only 9 of the 498 patients (1.8%) with a tumour <3 cm developed distant metastases after surgery. • Each 1‐cm increase in tumour size increased the risk of death from RCC by 20%[hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.18–1.22; P < 0.001] and death from any cause by 10% (HR 1.10; 95% CI 1.09–1.12; P < 0.001). • For the 1346 patients who were still alive at last follow‐up, the median (range) duration of follow‐up was 6.9 (0.1–19.7) years. CONCLUSIONS • Tumour size is significantly associated with metastases in patients with renal masses. • Patients with tumours <3 cm have a low risk of synchronous metastatic disease.