Objective
To compare the predictive ability for oncologic outcomes among current tumor size
cut-points and clinically relevant alternatives to determine which are optimal.
Methods
Patients who underwent radical or partial nephrectomy between 1970 and 2010 for T1-2Nx/N0M0
renal cell carcinoma (RCC) were identified. Associations between tumor size and progression-free
survival (PFS) and cancer-specific survival (CSS) were evaluated using Kaplan-Meier
analyses and Cox models. Predictive ability was assessed using c-indexes.
Results
The cohort included 3304 patients with a median age of 63 years (interquartile range
53, 70). Median follow-up among survivors was 9.9 years (interquartile range 6.9,
14.3). There were 536 patients who progressed and 354 who died from RCC. For RCC tumors
≤3.0 cm, 10-year PFS and CSS rates were 93%-95% and 97%-99%, respectively. For tumors
>3.0-4.0 cm, PFS and CSS began to decline (91% and 95%, respectively), with further
gradual declines in PFS and CSS with increasing tumor size. Plots of hazard ratios
for progression and RCC death as a function of tumor size did not reveal major inflection
points. Differences in discrimination based on various combinations of tumor-size
cut-points for progression or RCC death were small, with c-indexes ranging between
0.691-0.704 and 0.734-0.750, respectively.
Conclusion
RCC tumors ≤3.0 cm in size are associated with favorable outcomes. Thereafter, risks
of progression and RCC death increase gradually with tumor size, with no compelling
biological reason to endorse a given cut-point over another.
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Article info
Publication history
Published online: April 13, 2017
Accepted:
April 6,
2017
Received:
February 25,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
