Open Access

ARTICLE

Adverse pathologic characteristics in the small renal mass: implications for active surveillance

Jamil S. Syed¹, Cayce B. Nawaf¹, James Rosoff¹, Campbell Bryson¹, Kevin A. Nguyen¹, Alfredo Suarez-Sarmiento¹, Maria Serrano², Adam S. Kibel⁴, Peter Humphrey³, Brian Shuch¹, Adebowale J. Adeniran³

1 Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
2 Department of Pathology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
3 Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
4 Division of Urology, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Address correspondence to Dr. Brian Shuch, Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT 06520-8058 USA

Canadian Journal of Urology 2017, 24(2), 8759-8764.

Abstract

Introduction: Evidence has demonstrated that tumor size is related to adverse oncologic outcomes in small renal tumors (≤ 4 cm). We evaluated the association of adverse pathologic features (APF) with tumor size and survival in patients with a small renal mass (SRM).
Materials and methods: We retrospectively reviewed the pathologic characteristics of 380 surgically resected SRMs from a single institution. APFs included lymphovascular invasion, coagulative necrosis, sarcomatoid/rhabdoid features, papillary type II histology, and perinephric fat/renal sinus invasion. The number and type of APFs were compared with tumor size. Survival analysis was performed using the Kaplan-Meier method.
Results: There were 244 (64.2%) males and 136 (35.8%) females. The median age was 61 years, and median tumor size was 2.7 cm. The median follow up time was 65 months. A significant association was found between tumor size and presence of APFs (p = 0.018). At least 1 APF could be found in 22%, 32%, 36%, and 49% of tumors ≤ 1 cm, 1 cm-2 cm, 2 cm-3 cm, and 3 cm-4 cm, respectively. There were no differences in overall survival or recurrence free survival when compared by tumor size at diagnosis (p = 0.22 and 0.15 respectively). Compared to patients with ≤ 1 APFs, disease specific survival was worse for patients with ≥ 2 APFs (p < 0.002).
Conclusion: Our data support that aggressive tumor biology in a SRM is associated with greater size. In patients with a SRM, the decision to pursue active surveillance and the trigger for intervention should take tumor size and APFs into consideration as this may have future oncologic implications.

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