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AJR Am J Roentgenol. 2004 Mar;182(3):551-7.

Small renal cell carcinomas: correlation of size with tumor stage, nuclear grade, and histologic subtype.

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  • 1Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, 601 N Caroline St., Baltimore, MD 21287, USA.

Abstract

OBJECTIVE:

Our goal was to correlate the size of renal cell carcinoma with tumor stage, nuclear grade, and histologic subtype in patients treated using partial or radical nephrectomy.

MATERIALS AND METHODS:

We retrospectively reviewed 213 consecutive renal cell carcinomas resected at our institution from 1995 through 1999. Three groups of lesions stratified by size (< or = 3 cm, > 3-5 cm, > 5 cm) were compared with regard to pathologic findings. Statistical significance was assessed using Fisher's exact test.

RESULTS:

Of 50 lesions 3 cm or smaller, 19 (38%) had extension outside the renal capsule (T3 or T4) and 14 (28%) were a high nuclear grade (Fuhrman grade 3 or 4). Lesions 3 cm or smaller and those greater than 3 cm to 5 cm did not differ statistically with regard to T stage or nuclear grade. Lesions larger than 5 cm showed a statistically higher T stage (p < 0.001) and nuclear grade (p = 0.001) than the other smaller lesions. More non-clear cell tumors were found in the two groups of smaller lesions (p = 0.105) but without statistical significance. The majority (58%) of the tumors were asymptomatic and had been detected incidentally on cross-sectional imaging. Lesions larger than 5 cm were significantly more likely to be symptomatic (p < 0.001). Seventy-nine percent of the tumors 3 cm or smaller were incidental, and these lesions did not differ significantly from the symptomatic lesions with regard to stage, grade, or histology.

CONCLUSION:

In our study population, renal cell carcinomas up to 3 cm, including asymptomatic lesions, showed a significant incidence of high nuclear grade and tumor extension beyond the renal capsule; these findings support aggressive management of small lesions. Symptomatic status was not an adequate discriminator to guide management. A longitudinal study is necessary to further evaluate the efficacy of current patterns of therapy.

PMID:
14975944
[PubMed - indexed for MEDLINE]
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