Abstract
Objective
To analyze the full spectrum of patients presenting with radiologically-identified
infiltrative renal masses (IRMs), including those managed surgically or otherwise,
with focus on clinical presentation/prognosis.
Methods
All 280 patients presenting with radiologically-identified renal mass with infiltrative
features (2008-2017) were retrospectively reviewed. Poorly-defined interface between
tumor and parenchyma and irregular shape (nonelliptical) in one or more distinct/unequivocal
areas were required for classification as IRM. IRM was confirmed in 265 and clinical
characteristics and outcomes were assessed.
Results
Median age/tumor size were 65-years/6.9 cm, respectively, and 225 patients (85%) were
R.E.N.A.L. = 10-12. Overall, 181 patients (68%) presented symptomatically, locally-advanced
cancer (cT3-T4) was observed in 176 (66%) and disseminated disease and/or lymphadenopathy
(>2 cm) in 181(68%). Clinical/radiographic findings were suggestive of etiology and
could direct evaluation, but were nonspecific for definitive diagnosis. Renal-mass
biopsy was performed in 103 patients and diagnostic in 97 (94%). Renal surgery was
only performed in 82 patients (31%) and partial nephrectomy in 3 (1.1%). Overall,
72 patients (27%) received systemic chemotherapy and 59 (22%) targeted therapy. Final-diagnosis
was renal cell carcinoma in 94 patients (35%), including 49 with highly-aggressive
histology (sarcomatoid/rhabdoid/collecting-duct/medullary/unclassified). High-grade
urothelial-carcinoma was found in 70 (26%), and lymphoma/metastatic cancer in 26 (10%)/25
(9%), respectively. Overall, 153 patients (58%) died; 138 (52%) cancer-related at
median of 5 months. The majority of patients with renal cell carcinoma, urothelial-carcinoma,
and renal metastasis died, almost exclusively cancer-related, at medians of 8, 3,
and 2 months, respectively.
Conclusion
Our series includes the full spectrum of IRMs and confirms predominance of symptomatic,
poorly-differentiated, highly-lethal malignancies. Our study highlights the overriding
importance of identifying infiltrative features, a simple radiologic diagnosis, during
assessment of renal masses.
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Article info
Publication history
Published online: May 07, 2019
Accepted:
April 27,
2019
Received:
March 4,
2019
Footnotes
Financial Disclosures: None of the authors have any disclosures or conflicts of interest to report.
Funding: Dr. Wang is funded by China Scholarship Council (grant 201706175045). Dr. Tanaka is funded by the Mochida Memorial Foundation for Medical and Pharmaceutical Research (grant 2017-StudyAbroad4-2).
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