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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (4): 623-627. doi: 10.19723/j.issn.1671-167X.2019.04.004

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Clinical and pathological analysis of small renal cell carcinoma

Xiao-peng ZHANG,Zi-xiong HUANG,Lu-ping YU,Xiao-wei ZHANG,Qing LI,Shi-jun LIU,Tao XU()   

  1. Department of Urology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2019-03-18 Online:2019-08-18 Published:2019-09-03
  • Contact: Tao XU E-mail:xutao@pkuph.edu.cn

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Abstract:

Objective: To analyze the clinical and pathological features of small renal cell carcinoma (RCC), especially of those with diameter less than 4 cm and to understand the characteristics and factors related to recurrence and progression.Methods: A total of 200 patients with RCC were stratifiedly selected for retrospective analysis. Their baseline demographic features, tumor-specific clinical features, pathological features of renal lesions, especially microscopic features were collected. The patients were divided according to the largest diameter of renal tumor lesions. Univariate analysis was used to compare the differences between tumor staging and microscopic pathological features between the groups. Binary multivariate Logistic regression was used to investigate factors related to tumor progression and prognosis in the patients with small RCC.Results: The tumor diameters of 127 RCC patients were less than 4 cm and most of them had clear cell renal cell carcinoma (ccRCC). The increase in tumor diameter resulted in significantly higher T stage (P<0.01), higher WHO/International Society of Urological Pathology (ISUP) grade (P<0.05) and increasing chance of lymph node metastasis (P<0.01). Even when the tumor diameter was less than 4 cm, the patients might still have perirenal fat invasion, renal sinus invasion and greater elevated tumor grade (greater than grade 3) and synchronous lung metastasis. The incidences of intravascular thrombus (9.3% vs. 0) and tumor necrosis (27.8% vs. 5.5%) in the patients with RCC between 4-7 cm were significantly higher than those with RCC less than 4 cm (P<0.01). Sub-group analysis of small RCC (less than 4 cm) indicated that the patients with RCC between 2-4 cm were more likely to have intratumoral hemorrhage (44.7% vs. 23%, P<0.05) and necrosis than those with RCC less than 2 cm (8.2% vs. 0, P=0.095). Logistic regression analysis of small RCC showed that the incidence of tumor invasion to renal capsule was higher in ccRCC (OR=5.15, 95%CI: 1.36-19.52). Necrosis was closely related to the formation of peritumor pseudocapsule in small RCC (OR=14.90, 95%CI: 1.41-157.50). Increase in the tumor diameter was related to higher tumor grade (greater than grade 3) (OR=3.49, 95%CI: 1.11-10.93).Conclusion: The tumor stage and grade of small RCC (less than 4 cm) are low, but extra-renal invasion and synchronous distant metastasis may occur. Internal hemorrhage and necrosis in tumor, ccRCC subtype, along with microscopic features, such as the renal capsule invasion and perirenal pseudocapsule formation are relevant factors of malignant behavior of small RCC and could be considered in prognosis evaluation.

Key words: Renal cell carcinoma, Tumor stage and grade, Pathological characteristics, Clinical characteristics

CLC Number: 

  • R737.11

Table 1

The baseline and clinical features of renal cell carcinoma patients"

Items Total (n=200) Group S1 (n=127) Group S2 (n=54) Group L (n=19) P value
Male, n (%) 145 (72.5) 90 (70.9) 41 (75.9) 14 (73.7) 0.778
Age/years, x?±s 57.91±12.09 58.52±12.03 56.61±12.71 57.53±10.81 0.338
BMI/(kg/m2), x?±s 25.08±3.34 25.07±2.80 24.81±3.63 25.83±5.38 0.641
Operation (RN), n (%) 89 (44.5) 30 (23.6) 43 (79.6) 16 (84.2) <0.01
Side (left), n (%) 102 (51.0) 62 (48.8) 26 (48.1) 14 (73.7) 0.038
T stage (T1+T2/T3+T4), n 124/3 45/9 8/11 <0.01
WHO/ISUP grade (G1+G2/G3+G4), n 102/7 34/14 5/9 <0.01
N1, n (%) 0 (0) 4 (7.4) 3 (15.8) 0.016
M1, n (%) 1 (0.8) 3 (5.6) 6 (31.6) <0.01

Table 2

The clinical and pathological features of patients with renal cell carcinoma less than 7 cm"

Items Group S1
(n=127)		 Group S2
(n=54)		 P value
Histology, n (%) 0.306
ccRCC 104 (81.89) 43 (79.63)
pRCC 5 (3.94) 2 (3.70)
chRCC 4 (3.15) 1 (1.85)
ccpRCC 2 (1.57) 0
Other 12 (9.45) 8 (14.81)
T stage (T1/T3+T4), n 124/3 45/9 <0.01
WHO/ISUP grade (G1+G2/G3+G4), n 102/7 34/14 <0.01
N1, n (%) 0 4 (7.4) <0.01
M1, n (%) 1 (0.8) 3 (5.6) 0.08
Renal capsular invasion,
n (%)		 40 (31.5) 25 (46.3) 0.058
Peritumor pseudocapsule,
n (%)		 8 (5.5) 3 (5.6) 0.99
Sarcomatoid, n (%) 0 1 (1.9) 0.298
Intravascular thrombus,
n (%)		 0 5 (9.3) <0.01
Hemorrhage, n (%) 48 (37.8) 18 (33.3) 0.568
Necrosis, n (%) 7 (5.5) 15 (27.8) <0.01

Table 3

The clinical and pathological features of patients with small renal cell carcinoma less than 4 cm"

Items Total (n=127) Tumor ≤ 2 cm (n=42) Tumor > 2 cm (n=85) P value
Operation (PN), n (%) 37 (88.1) 60 (70.6) 0.029
T stage (T1/T3+T4), n 124/3 41/1 83/2 >0.99
WHO/ISUP grade (G1+G2/G3+G4), n 102/7 33/1 69/6 0.431
Renal capsular invasion, n (%) 40 (31.5) 15 (35.7) 25 (29.4) 0.472
Peritumor pseudocapsule, n (%) 7 (5.5) 2 (4.8) 5 (5.9) >0.99
Hemorrhage, n (%) 44 (34.6) 10 (23.8) 38 (44.7) 0.022
Necrosis, n (%) 7 (5.5) 0 (0) 7 (8.2) 0.095

Table 4

Logistic regression model showing adverse pathological features of patients with small renal cell carcinoma less than 4 cm"

Variable Occurrence/Total, n (%) OR 95%CI P value
Renal capsular invasion
Histology (clear cell carcinoma) 37/104 (35.6) 5.15 1.36-19.52 0.02
Hemorrhage 12/48 (25.0) 0.55 0.23-1.32 0.18
Cystic degeneration 12/44 (27.3) 0.66 0.27-1.60 0.36
Necrosis 2/7 (28.6) 0.87 0.14-5.39 0.88
Size (per cm increased) 0.94 0.59-1.48 0.78
Peritumor pseudocapsule
Histology (clear cell carcinoma) 6/104 (5.8) 0.59 0.05-7.19 0.68
Hemorrhage 4/48 (8.3) 1.21 0.21-7.01 0.83
Necrosis 2/7 (28.6) 14.90 1.41-157.50 0.03
Cystic degeneration 4/44 (9.1) 0.96 0.53-29.64 0.18
Size (per cm increased) 1.08 0.14-20.90 0.88
WHO/ISUP grade 3 or 4
Hemorrhage 3/46 (6.5) 0.75 0.14-4.14 0.74
Cystic degeneration 2/44 (4.5) 0.41 0.63-2.71 0.36
Size (per cm increased) 3.49 1.11-10.93 0.03
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