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The Complete Spectrum of Infiltrative Renal Masses: Clinical Characteristics and Prognostic Implications

  • Author Footnotes
    1 Drs. Wang, Tanaka, and Ye each contributed fully and equally to this work.
    Yanbo Wang
    Footnotes
    1 Drs. Wang, Tanaka, and Ye each contributed fully and equally to this work.
    Affiliations
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH

    Department of Urology, First Hospital of Jilin University, Changchun, China
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  • Author Footnotes
    1 Drs. Wang, Tanaka, and Ye each contributed fully and equally to this work.
    Hajime Tanaka
    Footnotes
    1 Drs. Wang, Tanaka, and Ye each contributed fully and equally to this work.
    Affiliations
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH

    Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
    Search for articles by this author
  • Author Footnotes
    1 Drs. Wang, Tanaka, and Ye each contributed fully and equally to this work.
    Yunlin Ye
    Footnotes
    1 Drs. Wang, Tanaka, and Ye each contributed fully and equally to this work.
    Affiliations
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH

    Department of Urology Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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  • Xiaobo Ding
    Affiliations
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH

    Department of Radiology, First Hospital of Jilin University, Changchun, China

    Imaging Institute, Cleveland Clinic, Cleveland, OH
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  • Ryan D. Ward
    Affiliations
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH

    Imaging Institute, Cleveland Clinic, Cleveland, OH
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  • Rebecca A. Campbell
    Affiliations
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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  • Molly E. DeWitt-Foy
    Affiliations
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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  • Chalairat Suk-Ouichai
    Affiliations
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH

    Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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  • Erick M. Remer
    Affiliations
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH

    Imaging Institute, Cleveland Clinic, Cleveland, OH
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  • Steven C. Campbell
    Correspondence
    Address correspondence to: Steven C. Campbell, M.D., Ph.D., Glickman Urologic and Kidney Institute, Cleveland Clinic, Center for Urologic Oncology, Room Q10-120, 9500 Euclid Avenue, Cleveland, OH 44195.
    Affiliations
    Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
    Search for articles by this author
  • Author Footnotes
    1 Drs. Wang, Tanaka, and Ye each contributed fully and equally to this work.

      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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