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Title: The Complete Spectrum of Infiltrative Renal Masses: Clinical Characteristics and Prognostic Implications
Authors: Yanbo Wang
Hajime Tanaka
Yunlin Ye
Xiaobo Ding
Ryan D. Ward
Rebecca A. Campbell
Molly E. DeWitt-Foy
Chalairat Suk-Ouichai
Erick M. Remer
Steven C. Campbell
The First Bethune Hospital of Jilin University
Sun Yat-Sen University Cancer Center
Cleveland Clinic Foundation
Faculty of Medicine, Siriraj Hospital, Mahidol University
Tokyo Medical and Dental University
Keywords: Medicine
Issue Date: 1-Aug-2019
Citation: Urology. Vol.130, (2019), 86-92
Abstract: © 2019 Elsevier Inc. Objective: To analyze the full spectrum of patients presenting with radiologically-identified infiltrative renal masses (IRMs), including those managed surgically or otherwise, with focus on clinical presentation/prognosis. Methods: All 280 patients presenting with radiologically-identified renal mass with infiltrative features (2008-2017) were retrospectively reviewed. Poorly-defined interface between tumor and parenchyma and irregular shape (nonelliptical) in one or more distinct/unequivocal areas were required for classification as IRM. IRM was confirmed in 265 and clinical characteristics and outcomes were assessed. Results: Median age/tumor size were 65-years/6.9 cm, respectively, and 225 patients (85%) were R.E.N.A.L. = 10-12. Overall, 181 patients (68%) presented symptomatically, locally-advanced cancer (cT3-T4) was observed in 176 (66%) and disseminated disease and/or lymphadenopathy (>2 cm) in 181(68%). Clinical/radiographic findings were suggestive of etiology and could direct evaluation, but were nonspecific for definitive diagnosis. Renal-mass biopsy was performed in 103 patients and diagnostic in 97 (94%). Renal surgery was only performed in 82 patients (31%) and partial nephrectomy in 3 (1.1%). Overall, 72 patients (27%) received systemic chemotherapy and 59 (22%) targeted therapy. Final-diagnosis was renal cell carcinoma in 94 patients (35%), including 49 with highly-aggressive histology (sarcomatoid/rhabdoid/collecting-duct/medullary/unclassified). High-grade urothelial-carcinoma was found in 70 (26%), and lymphoma/metastatic cancer in 26 (10%)/25 (9%), respectively. Overall, 153 patients (58%) died; 138 (52%) cancer-related at median of 5 months. The majority of patients with renal cell carcinoma, urothelial-carcinoma, and renal metastasis died, almost exclusively cancer-related, at medians of 8, 3, and 2 months, respectively. Conclusion: Our series includes the full spectrum of IRMs and confirms predominance of symptomatic, poorly-differentiated, highly-lethal malignancies. Our study highlights the overriding importance of identifying infiltrative features, a simple radiologic diagnosis, during assessment of renal masses.
ISSN: 15279995
Appears in Collections:Scopus 2019

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