Email Alert | RSS

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

Previous Articles     Next Articles

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

RICH HTML

   

PDF (PC)

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
[1] Kim SP, Thompson RH, Boorjian SA , et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: A systematic review and meta-analysis[J]. J Urol, 2012,188(1):51-57.
[2] Van Poppel H, Pozzo LF, Albrecht W , et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma[J]. Eur Urol, 2007,59(4):543-552.
[3] Long CJ, Canter D, Kutikov A , et al. Partial nephrectomy for renal masses ≥ 7 cm: technical, oncological and functional outcomes[J]. BJU Int, 2012,109(10):1450-1456.
[4] Ljungberg B . Nephron-sparing surgery strategy: the current stan-dard for the treatment of localised renal cell carcinoma[J]. Eur Urol Suppl, 2011,10(3):e49-e51.
[5] Thompson RH, Blute ML, Krambeck AE , et al. Patients with pT1 renal cell carcinoma who die from disease after nephrectomy may have unrecognized renal sinus fat invasion[J]. Am J Surg Pathol, 2007,31(7):1089-1093.
[6] Feifer A, Savage C, Rayala H , et al. Prognostic impact of muscular venous branch invasion in localized renal cell carcinoma cases[J]. J Urol, 2011,185(1):37-42.
[7] Huang Z, Du Y, Zhang X , et al. Clear cell renal cell carcinoma bone metastasis: What should be considered in prognostic evaluation[J]. Eur J Surg Oncol, 2019,45(7):1246-1252.
[8] Forbes CM, Rendon RA, Finelli A , et al. Disease progression and kidney function after partial vs. radical nephrectomy for T1 renal cancer [J]. Urol Oncol, 2016, 34(11): 486. e17- 486. e23.
[9] Moch H, Cubilla AL, Humphrey PA , et al. The 2016 WHO classification of tumours of the urinary system and male genital organs—Part A: renal, penile, and testicular tumours[J]. Eur Urol, 2016,70(1):93-105.
[10] European Association of Urology. EAU guidelines [R]. EAU Annual Congress Copenhagen, 2018.
[11] Dash A, Vickers AJ, Schachter LR , et al. Comparison of outcomes in elective partial vs radical nephrectomy for clear cell renal cell carcinoma of 4-7 cm[J]. BJU Int, 2006,97(5):939-945.
[12] Crepel M, Jeldres C, Perrotte P , et al. Nephron-sparing surgery is equally effective to radical nephrectomy for T1BN0M0 renal cell carcinoma: A population-based assessment[J]. Urology, 2010,75(2):271-275.
[13] Lughezzani G, Jeldres C, Isbarn H , et al. Tumor size is a determinant of the rate of stage T1 renal cell cancer synchronous metastasis[J]. J Urol, 2009,182(4):1287-1293.
[14] Syed JS, Nawaf CB, Rosoff J , et al. Adverse pathologic characte-ristics in the small renal mass: implications for active surveillance[J]. Can J Urol, 2017,24(2):8759-8764.
[15] Sun M, Shariat SF, Cheng C , et al. Prognostic factors and predictive models in renal cell carcinoma: A contemporary review[J]. Eur Urol, 2011,60(4):644-661.
[16] Jeong IG, Jeong CW, Hong SK , et al. Prognostic implication of capsular invasion without perinephric fat infiltration in localized renal cell carcinoma[J]. Urology, 2006,67(4):709-712.
[17] Pickhardt PJ, Lonergan GJ, Davis CJ Jr , et al. From the archives of the AFIP. Infiltrative renal lesions: radiologicpathologic correlation. Armed Forces Institute of Pathology[J]. Radiographics, 2000,20:215-243.
[18] Cho S, Lee JH, Jeon SH , et al. A prospective, multicenter analysis of pseudocapsule characteristics: Do all stages of renal cell carcinoma have complete pseudocapsules?[J]. Urol Oncol, 2017,35(6):370-378.
[19] Capitanio U, Cloutier V, Zini L , et al. A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study[J]. BJU Int, 2009,103(11):1496-1500.
[20] Keegan KA, Schupp CW, Chamie K , et al. Histopathology of surgically treated renal cell carcinoma: Survival differences by subtype and stage[J]. J Urol, 2012,188(2):391-397.
[21] Kryvenko ON . Tumor necrosis adds prognostically significant information to grade in clear cell renal cell carcinoma: A study of 842 consecutive cases from a single institution[J]. Urol Oncol, 2017,35(6):454-455.
[22] Collins J, Epstein JI . Prognostic significance of extensive necrosis in renal cell carcinoma[J]. Hum Pathol, 2017,66:108-114.
[1] Fan SHU, Liyuan GE, Hanzhang DENG, Haoming YIN, Junyong OU, Shaohui DENG, Yichang HAO, Min LU, Zhanyi ZHANG, Peichen DUAN, Shudong ZHANG. Molecular characteristics for poor prognosis related renal cell carcinoma with lymph metastases [J]. Journal of Peking University (Health Sciences), 2026, 58(3): 631-640.
[2] Haoming YIN, Zijie WANG, Fan SHU, Zhanyi ZHANG, Hui LIANG, Shudong ZHANG. Expression and significance of the FABP6 long transcript in clear cell renal cell carcinoma [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 393-398.
[3] Boda GUO, Min LU, Guoliang WANG, Hongxian ZHANG, Lei LIU, Xiaofei HOU, Lei ZHAO, Xiaojun TIAN, Shudong ZHANG. Clinicopathological and prognostic differences between clear cell and non-clear cell renal cell carcinoma with venous tumor thrombus [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 644-649.
[4] Zhanyi ZHANG, Min LU, Yuehao SUN, Jinghan DONG, Xiaofei HOU, Chunlei XIAO, Guoliang WANG, Xiaojun TIAN, Lulin MA, Hongxian ZHANG, Shudong ZHANG. Clinicopathological features and survival analysis of TFE3-rearranged renal cell carcinoma with venous tumor thrombus [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 650-661.
[5] Zezhen ZHOU, Liyuan GE, Fan ZHANG, Shaohui DENG, Ye YAN, Hongxian ZHANG, Guoliang WANG, Lei LIU, Yi HUANG, Shudong ZHANG. A retrospective matching study of partial nephrectomy and radical nephrectomy for pathological T3a stage renal cell carcinoma [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 704-710.
[6] Fan SHU,Yichang HAO,Zhanyi ZHANG,Shaohui DENG,Hongxian ZHANG,Lei LIU,Guoliang WANG,Xiaojun TIAN,Lei ZHAO,Lulin MA,Shudong ZHANG. Functional and oncologic outcomes of partial nephrectomy for cystic renal cell carcinoma: A single-center retrospective study [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 667-672.
[7] Zezhen ZHOU,Shaohui DENG,Ye YAN,Fan ZHANG,Yichang HAO,Liyuan GE,Hongxian ZHANG,Guoliang WANG,Shudong ZHANG. Predicting the 3-year tumor-specific survival in patients with T3a non-metastatic renal cell carcinoma [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 673-679.
[8] Lu FENG,Jia-yu ZHAI,Jin-xia ZHAO. Medical visit status and clinical features in patients with IgG4 related disease [J]. Journal of Peking University (Health Sciences), 2023, 55(6): 1028-1032.
[9] Yun-chong LIU,Zong-long WU,Li-yuan GE,Tan DU,Ya-qian WU,Yi-meng SONG,Cheng LIU,Lu-lin MA. Mechanism of nuclear protein 1 in the resistance to axitinib in clear cell renal cell carcinoma [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 781-792.
[10] Dong LAN,Zhuo LIU,Yu-xuan LI,Guo-liang WANG,Xiao-jun TIAN,Lu-lin MA,Shu-dong ZHANG,Hong-xian ZHANG. Risk factors for massive hemorrhage after radical nephrectomy and removal of venous tumor thrombus [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 825-832.
[11] Yun-yi XU,Zheng-zheng SU,Lin-mao ZHENG,Meng-ni ZHANG,Jun-ya TAN,Ya-lan YANG,Meng-xin ZHANG,Miao XU,Ni CHEN,Xue-qin CHEN,Qiao ZHOU. Read-through circular RNA rt-circ-HS promotes hypoxia inducible factor 1α expression and renal carcinoma cell proliferation, migration and invasiveness [J]. Journal of Peking University (Health Sciences), 2023, 55(2): 217-227.
[12] Qi SHEN,Yi-xiao LIU,Qun HE. Mucinous tubular and spindle cell carcinoma of kidney: Clinicopathology and prognosis [J]. Journal of Peking University (Health Sciences), 2023, 55(2): 276-282.
[13] Quan ZHANG,Hai-feng SONG,Bing-lei MA,Zhe-nan ZHANG,Chao-hui ZHOU,Ao-lin LI,Jun LIU,Lei LIANG,Shi-yu ZHU,Qian ZHANG. Pre-operative prognostic nutritional index as a predictive factor for prognosis in non-metastatic renal cell carcinoma treated with surgery [J]. Journal of Peking University (Health Sciences), 2023, 55(1): 149-155.
[14] Min LI,Lin-qing HOU,Yue-bo JIN,Jing HE. Clinical and immunological characteristics of systemic lupus erythematosus with retinopathy [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1106-1111.
[15] Yu-xing GUO,Jian-yun ZHANG,Dian-can WANG,Chuan-bin GUO. Analysis of pathological characteristics of medication-related osteonecrosis of the jaw and discussion of clinical treatment strategies based on the pathological analysis results [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1190-1195.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd