“Many clinicians regard small renal cell cancer as having a benign
biologic behavior and non-operative surveillance protocols are often
being used in patients with small renal tumours,” write the authors in
the findings. “The aim of this large retrospective multi-centre study
was to evaluate the prevalence of locally advanced growth and distant
metastases in patients with small renal cell carcinomas following
The investigation included 2197 patients with RCC of 4 cm or smaller
in maximal tumour diameter and complete patient and tumour specific
characteristics from six centers in Germany between 1990 and 2011.
The risk of presenting nodal disease or distant metastasis increased
insignificantly with rising tumour diameter. After a mean follow-up of
more than 5 years, the tumour-associated death rates were 6.5, 7.6, and
8.4 % in the ≤ 2 cm, 2-3 cm, and 3-4 cm tumour diameter subgroups,
respectively. Kaplan-Meier 5-year cancer specific survival (CSS) rates
did not differ significantly: 93.3, 92.1, and 92.8 %.
Patients with no lymphatic or distant metastasis at the time of
diagnosis or surgery had a 5-year cancer specific death rate of 5.8 %.
5-year cancer related death rate was significantly higher among the 75
patients with nodal or distant involvement at the time of surgery
In conclusion, the authors stress that lymph node and distant
metastases occur even in small RCCs: “These results have significant
implications since the rate of patients diagnosed with small renal
masses is increasing and non-operative surveillance protocols are
currently being used in patients with small renal tumour."
Source: European Association of Urology