Adverse pathologic characteristics in the small renal mass: implications for active surveillance

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Small renal tumors (≤ 4 cm) are linked to poor oncologic outcomes.
• Adverse pathologic features (APFs) in small renal masses (SRMs) require further investigation regarding their association with tumor size and patient survival.

Purpose of the Study:

• To evaluate the association between tumor size and adverse pathologic features (APFs).
• To assess the impact of APFs and tumor size on survival outcomes in patients with SRMs.

Main Methods:

• Retrospective review of 380 surgically resected SRMs.
• Analysis of APFs including lymphovascular invasion, necrosis, sarcomatoid features, papillary II histology, and invasion.
• Correlation of APF presence/type with tumor size and Kaplan-Meier survival analysis.

Main Results:

• A significant association exists between SRM size and the presence of APFs (p=0.018).
• APF prevalence increased with tumor size, from 22% in tumors ≤1 cm to 49% in tumors 3-4 cm.
• While tumor size did not significantly affect overall or recurrence-free survival, ≥2 APFs were associated with worse disease-specific survival (p<0.002).

Conclusions:

• Aggressive tumor biology in SRMs is associated with larger tumor size.
• Tumor size and APFs should be considered in treatment decisions for SRMs, potentially influencing active surveillance or intervention timing.