Preop features predict pathology of small renal masses

Dec 17 2012

By Joanna Lyford, Senior medwireNews Reporter

Researchers have identified preoperative clinical and tumor characteristics that predict the risk for malignancy in patients undergoing partial nephrectomy for small renal masses.

The findings may help when counseling patients about treatment options ahead of surgery, say Jeffrey Mullins (James Buchanan Brady Urological Institute, Baltimore, Maryland, USA) and colleagues.

The study, published in the Journal of Urology, was a retrospective review of prospectively collected data on 873 clinically localized renal tumors treated with robot-assisted partial nephrectomy.

In all, 671 (76.9%) tumors were found to be malignant, with the predominant histology being clear-cell renal cell carcinoma, and 202 (23.1%) were benign.

The vast majority of demographic, clinical, and tumor characteristics were similar in patients with benign and malignant tumors.

However, patients with malignant tumors were more likely to be male (64.8% vs 43.6%), to have tumors in a hilar location, and to have tumors of intermediate or high complexity, as quantified by the "R.E.N.A.L." nephrometry score (ie, radius, exophytic/endophytic, nearness of tumor to collecting system or sinus, anterior/posterior, hilar and location relative to polar lines).

These differences were confirmed in multivariate analysis, which identified male gender versus female gender and intermediate and high tumor complexity versus low complexity as significant independent predictors for malignant pathology, with odds ratios of 4.28, 2.79, and 11.62, respectively.

These characteristics were also associated with a diagnosis of renal cell carcinoma and with clear-cell histology.

Noting that "a priori knowledge of the malignant and metastatic potential of a tumor would impact treatment decisions," Mullins et al conclude: "Patient and tumor characteristics should be considered when counseling patients on management options for small renal masses."

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