Urology Annals (Jan 2009)
Multicentricity and its associated clinicopathological risk factors in renal cell carcinoma
Abstract
Aims : Although nephron-sparing tumor surgery (NSS) has become a routine procedure for renal tumors under certain precautions in many centers, due to the incidence of multifocality, it still remains controversial. This study examines some clinical and pathological risk factors associated with multifocal renal tumors and also factors contributing to the success or failure of NSS. Materials and Methods: From 2000-2005, 130 patients with renal cell carcinoma (RCC) who had undergone radical nephrectomy were included in this study at one academic center. The clinicopathologic features of these cases were reviewed and categorized to identify risk factors of multifocality including age, gender, size and side of the tumor, presence of vascular invasion, Fuhrman′s grade, and clinical and pathological stages. Statistical Analysis: Data were expressed as mean. Statistical significance among groups was evaluated using Chi-square test and Fisher′s exact test when appropriate. Student′s t test was used for comparison of two means. Multiple logistic regression analysis was performed for risk factors of multicentricity. P < . 05 was considered to indicate statistical significance. Analyses were carried out with SPSS (version 13) software. Results : In all, 88 men and 42 women were included with a mean (range) age of 57 years. Vascular invasion, nuclear grade, and pathological and clinical stages of the primary tumors were the significant predictors of multicentricity in the statistical analyses. Conclusions : These data document that multifocality of RCCs is associated with presence of vascular invasion, high grade, and advanced staged tumors. Our results support the fact that NSS is an acceptable approach to RCC without these features, as oncological safety seems less evident in such cases and should be considered for absolute indications. Future trials should be performed with adequate funding and patient-focused outcomes.
