Small renal masses in Latin-American population: characteristics and prognostic factors for survival, recurrence and metastasis – a multi-institutional study from LARCG database
Thiago Camelo Mourão,
Diego Abreu,
Gustavo F. Carvalhal,
Guillermo Gueglio,
Walter H. da Costa,
Vinicius Fernando Calsavara,
Luis Meza-Montoya,
Rubén G. Bengió,
Carlos Scorticati,
Ricardo Castillejos-Molina,
Francisco Rodríguez-Covarrubias,
Ana María Autran-Gómez,
José Gadu Campos-Salcedo,
Alejandro Nolazco,
Carlos Ameri,
Hamilton Zampolli,
Raúl Langenhin,
Diego Muguruza,
Marcos Tobias Machado,
Pablo Mingote,
Jorge Clavijo,
Lucas Nogueira,
Omar Clark,
Agustín R. Rovegno,
Fernando P. Secin,
Ricardo Decia,
Gustavo C. Guimarães,
Sidney Glina,
Oscar Rodríguez-Faba,
Joan Palou,
Stenio C. Zequi
Affiliations
Thiago Camelo Mourão
A.C. Camargo Cancer Center
Diego Abreu
Pasteur Hospital
Gustavo F. Carvalhal
São Lucas Hospital – PUCRS
Guillermo Gueglio
Italian Hospital
Walter H. da Costa
A.C. Camargo Cancer Center
Vinicius Fernando Calsavara
Epidemiology and Statistics Department, International Research Center, A.C.Camargo Cancer Center
Luis Meza-Montoya
Instituto Nacional de Enfermedades Neoplásicas
Rubén G. Bengió
Urological Center Profesor Bengió
Carlos Scorticati
Clinics Hospital José de San Martín
Ricardo Castillejos-Molina
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCNSZ)
Francisco Rodríguez-Covarrubias
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCNSZ)
Ana María Autran-Gómez
Jiménez Díaz Foundation
José Gadu Campos-Salcedo
Military Hospital
Alejandro Nolazco
British Hospital
Carlos Ameri
German Hospital
Hamilton Zampolli
Instituto Arnaldo Vieira de Carvalho
Raúl Langenhin
Corporación Médica de Paysandú (COMEPA)
Diego Muguruza
Corporación Médica de Paysandú (COMEPA)
Marcos Tobias Machado
Instituto Arnaldo Vieira de Carvalho
Pablo Mingote
Policlinico Neuquén
Jorge Clavijo
Clinics Hospital
Lucas Nogueira
Federal University of Minas Gerais
Omar Clark
Military Hospital
Agustín R. Rovegno
Centro de Educación Médica e Investigaciones Clínicas (CEMIC)
Fernando P. Secin
San Lázaro Foundation and FUNDES
Ricardo Decia
Pasteur Hospital
Gustavo C. Guimarães
Surgical Oncology Coordinator at Beneficencia Portuguesa Hospital
Abstract Background To evaluate demographic, clinical and pathological characteristics of small renal masses (SRM) (≤ 4 cm) in a Latin-American population provided by LARCG (Latin-American Renal Cancer Group) and analyze predictors of survival, recurrence and metastasis. Methods A multi-institutional retrospective cohort study of 1523 patients submitted to surgical treatment for non-metastatic SRM from 1979 to 2016. Comparisons between radical (RN) or partial nephrectomy (PN) and young or elderly patients were performed. Kaplan-Meier curves and log-rank tests estimated 10-year overall survival. Predictors of local recurrence or metastasis were analyzed by a multivariable logistic regression model. Results PN and RN were performed in 897 (66%) and 461 (34%) patients. A proportional increase of PN cases from 48.5% (1979–2009) to 75% (after 2009) was evidenced. Stratifying by age, elderly patients (≥ 65 years) had better 10-year OS rates when submitted to PN (83.5%), than RN (54.5%), p = 0.044. This disparity was not evidenced in younger patients. On multivariable model, bilaterality, extracapsular extension and ASA (American Society of Anesthesiologists) classification ≥3 were predictors of local recurrence. We did not identify significant predictors for distant metastasis in our series. Conclusions PN is performed in Latin-America in a similar proportion to developed areas and it has been increasing in the last years. Even in elderly individuals, if good functional status, sufficiently fit to surgery, and favorable tumor characteristics, they should be encouraged to perform PN. Intending to an earlier diagnosis of recurrence or distant metastasis, SRM cases with unfavorable characteristics should have a more rigorous follow-up routine.
