Abstract
Objective
To perform a comprehensive histopathologic review of sporadic resected solitary cT1
renal masses comparing those with and without radiographic involvement of the hilum.
Materials and Methods
A prospectively maintained database was queried for all cT1 renal masses undergoing
resection classified per the R.E.N.A.L. nephrometry score. Hilar masses were defined
as tumors that abut the main renal artery or vein on cross-sectional imaging. Demographic,
treatment, renal mass, and histopathologic characteristics were compared between hilar
and nonhilar renal masses. Multivariate regression model analyses were performed to
assess factors associated with renal mass upstaging and disease recurrence.
Results
A total of 1324 stage 1 renal masses met criteria for analysis of which 226 (17.1%)
were defined as hilar. Hilar masses were larger, scored with higher complexity, and
more likely to undergo a radical nephrectomy. On histopathologic analysis, we found
no difference between hilar and nonhilar masses regarding the incidence of malignancy,
presence of high nuclear grade, or risk of upstaging. On multivariate analysis, a
tumor's hilar location was not associated with upstaging or disease recurrence.
Conclusion
We present a comprehensive histopathologic review of a large cohort of cT1 hilar lesions
noting no difference in the risk of malignancy, high nuclear grade, upstaging, or
recurrence when compared to nonhilar lesions. Together, these data suggest that there
is no compelling cancer-specific rationale to perform a radical nephrectomy when managing
renal hilar tumors.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Renal masses herniating into the Hilum: technical considerations of the “ball-valve phenomenon” during nephron sparing surgery.Urology. 2010; 75: 707-710
- The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth.J Urol. 2009; 182: 844-853
- An arterial based complexity (ABC) scoring system to assess the morbidity profile of partial nephrectomy.Eur Urol. 2016; 69: 72-79
- Renal mass and localized renal cancer: AUA guideline.J Urol. 2017; 198: 520-529
- Anatomic features of enhancing renal masses predict malignant and high-grade pathology: a preoperative nomogram using the RENAL nephrometry score.Eur Urol. 2011; 60: 241-248
- External validation of a nomogram using RENAL nephrometry score to predict high grade renal cell carcinoma.J Urol. 2012; 187: 1555-1560
- Renal lesions with low R.E.N.A.L nephrometry score are associated with more indolent renal cell carcinomas (RCCs) or benign histology: findings in an Australian cohort.BJU Int. 2012; 109: 44-47
- Outcomes and predictors of clinical T1 to pathological T3a tumor up-staging after robotic partial nephrectomy: a multi-institutional analysis.J Urol. 2013; 190: 1907-1911
- Multi-institutional analysis of robotic partial nephrectomy for hilar versus nonhilar lesions in 446 consecutive cases.Eur Urol. 2011; 59: 325-330
- The impact of tumour location on the histological subtype of renal cortical tumours.BJU Int. 2006; 98: 63-66
- Tumour location as a predictor of benign disease in the management of renal masses.Can Urol Assoc J. 2010; 4: 414-417
- Robot-assisted partial nephrectomy: a large single-institutional experience.Urology. 2010; 75: 1328-1334
- Nephron sparing surgery for renal tumors: indications, techniques and outcomes.J Urol. 2001; 166: 6-18
- Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery.Eur Urol. 2009; 56: 786-793
- Kidney tumor location measurement using the C index method.J Urol. 2010; 183: 1708-1713
- Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy.Eur Urol. 2011; 60: 724-730
- R.E.N.A.L. score outperforms PADUA score, C-index and DAP score for outcome prediction of nephron sparing surgery in a selected cohort.J Urol. 2016; 196: 664-671
- R.E.N.A.L. nephrometry score accurately predicts complications following laparoscopic renal cryoablation.J Urol. 2012; 188: 1796-1800
- Usefulness of R.E.N.A.L. nephrometry scoring system for predicting outcomes and complications of percutaneous ablation of 751 renal tumors.J Urol. 2013; 189: 30-35
- Small renal masses in close proximity to the collecting system and renal sinus are enriched for malignancy and high fuhrman grade and should be considered for early intervention.Clin Genitourin Cancer. 2018; 16: e729-e733
- A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma.J Urol. 2005; 173: 48-51
- Dynamic outcome prediction in patients with clear cell renal cell carcinoma treated with radical nephrectomy: the D-SSIGN score.J Urol. 2007; 177: 477-480
- Late recurrence of renal cell carcinoma >5 years after surgery: clinicopathological characteristics and prognosis.BJU Int. 2012; 110: E553-E558
Article info
Publication history
Published online: October 06, 2018
Footnotes
Financial Sources: This publication was supported in part by grants from the National Cancer Institute (P30 CA006927), funding from the Betz Family Endowment for Cancer Research, and the Gitlin, Scheller, Foundations. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.
Conflicts of Interest: None.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
