Nephron-sparing surgery for renal cell carcinoma—is tumor size a suitable parameter for indication?

• Published in: Urology (Ridgewood, N.J.) N.J.), 1999-12, Vol.54 (6), p.988-993
• Main Authors: Miller, Joerg, Fischer, Claus, Freese, Roland, Altmannsberger, Michael, Weidner, Wolfgang
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Female; Humans; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Medical sciences; Middle Aged; Neoplasm Staging; Nephrons; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Urologic Surgical Procedures - methods
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(99)00347-7

Objectives. Because patients with small renal cell carcinomas (RCC) are being treated by nephron-sparing surgery with increased frequency, a generally accepted parameter giving additional information as to which kind of tumor is suitable for this treatment is urgently required. Methods. In a retrospective analysis of 245 patients who underwent radical nephrectomy for RCC, we investigated whether tumor size could provide the necessary information. We analyzed the association of tumor size with pTNM classification, grade, and the findings of the flow cytometric analysis of the DNA content analyzing the DNA index (DI). Results. Stage pT1 was found in 23 patients (9.4%), pT2 in 100 (40.8%), pT3 in 109 (44.5%), and pT4 in 13 patients (5.3%). Grade 1 was found in 87 patients (35.5%), grade 2 in 120 (49.0%), and grade 3 in 38 patients (15.5%). A low DI was found in 71%, a moderately increased DI in 20%, and a high DI in 9%. Lymph node metastases were detected in 14% and distant metastases in 22%. Closer examination of the tumors less than 2.5 cm (n = 23) revealed a significantly lower incidence ( P