Are Small Renal Tumors Harmless? Analysis of Histopathological Features According to Tumors 4 Cm or Less in Diameter

作者：Mesut Remzi, Mehmet Özsoy, Hans‐Christoph Klingler, Martin Susani, Matthias Waldert, Christian Seitz, Joerg Schmidbauer, Michael Marberger · 发表于：The Journal of Urology · 年份：2006 · DOI：10.1016/j.juro.2006.04.047 · 被引用次数：348 · 研究领域：Renal cell carcinoma treatment、Renal and related cancers、Multiple and Secondary Primary Cancers

PURPOSE: Small renal tumors detected incidentally are considered to have less aggressive potential. This assumption is mainly based on the low tendency to increase in size on serial imaging studies, but histopathological parameters of progression in larger patient series are scant. MATERIALS AND METHODS: We reviewed data of 287 tumor bearing kidneys in which solid tumors 4 cm or less in diameter were detected by cross-sectional imaging and subsequently removed surgically. Tumor size as documented by preoperative computerized tomography was correlated to histological diagnosis, and in cases of malignancy correlated to tumor type, pathological TNM stage and nuclear (Fuhrman) grade. With multifocal lesions the largest single tumor was considered the reference lesion but multifocality was also considered a separate parameter. RESULTS: At a mean tumor diameter of 2.94 +/- 0.87 cm 65 (22.6%) tumors were 2 cm or less, 103 (35.9%) were 2.1 to 3.0 cm and 119 (41.5%) were 3.1 to 4 cm in diameter. A total of 56 (19.5%) tumors were benign with no correlation to tumor size (Pearson test p = 0.660). Renal cell cancer was found in 227 (79.1%) patients with 159 (70.0%) clear cell, 47 (20.7%) papillary, 11 (4.8%) chromophobe and 10 others with no correlation to tumor diameter. Of the kidneys 31 (13.6%) had multifocal renal cell carcinoma, with a significant correlation to larger tumor diameter (linear regression p = 0.048) and papillary renal cell carcinoma subtype (linear regression p = 0.01...