Introduction and objectives
It is known that partial nephrectomy(PN) or radical nephrectomy(RN) is standard treatment for localized renal cell carcinoma(RCC). PN is preferred for small renal masses(T1a stage, <4.0 cm) whenever practicable. Due to the development of surgical techniques, It has recently implemented in T1b-2 renal masses, selectively. This research examines the availability of tumor contour irregularity (TCI) to predict oncologic outcome of localized RCC after PN.
Methods
Patients who underwent PN for clinically localized RCC(T1 stage, ≤ 7 cm) with no evident venous or perirenal/sinus fat invasion on imaging were examined. TCIs were confirmed by CT/MRI reviewing before surgery, and it was classified into three groups according to tumor shape and contour. : TCI 0 (entirely elliptical shape and smooth contour), 1 (partially [<50%] irregular contour), 2 (extensively [≥50%] irregular contour).
Results
The total number of patients included in this study is 192. Median tumor size was 2.55 cm and male to female ratio was 2.25(n=133) to 1(n=59). TCIs were reported as 0/1/2 in 48(25%)/86(44.8%)/58(30.2%) patients, respectively. Upstaging to pathological T3a(n=4) occurred in the TCI 2 with a significantly higher probability than in the other groups(0%/0%/6.9% for TCI 0/1/2, p<0.05 ). 17 patients (8.9% of total) reported recurrence of cancer during median follow-up of 57 months. There was significantly higher recurrence rate from higher TCI(4.2%/5.8%/17.2% for TCI 0/1/2, p<0.05).
Conclusions
The higher the TCI stage, the more likely it is that pathological upstaging and local recurrence will occur. In conclusion, the classification of TCI could be a prognostic factor that can be used to predict oncological outcomes.
Source of Funding
none