Small renal masses (SRMs) include solid, cortical tumors less than 4cm that are confined to the kidney (AJCC clinical tumor stage, cT1a). The majority of these tumors are cured with partial nephrectomy or can be safely monitored in an active surveillance program. However, when removed some can demonstrate aggressive features (like invasion into the fat or blood vessels surrounding the kidney, AJCC pathological tumor stage, pT3a) and have a higher risk of recurrence or death from kidney cancer. Occasionally, patients will have a CT scan or MRI that indicates that their SRM is touching the sinus fat and ask in clinic, does that mean it is aggressive and I am not a candidate for active surveillance? Here we review the data about SRM with potentially aggressive features.
|Michael Gorin, MD|
|Mohamad E. Allaf, MD|
Drs. Gorin and Allaf then looked to see if imaging characteristics prior to surgery were predictive of upstaging. They found that increasing tumor size and tumors close to the renal hilum were independent risk factors for upstaging from cT1a to pT3a.
Therefore, they drew a number of conclusions from this data:
- It is rare for a small renal tumor to actually be invasive and simply touching the fat on imaging does not necessarily mean it is invading it.
- Patients with small renal tumors touching the sinus fat are still candidates for active surveillance understanding that larger tumors that are hilar (close to the kidney blood vessels) are more likely to be invasive .
- For these tumors, we typically advocate a more aggressive approach.
Read the entire manuscript:
Gorin MA, Ball MW, Pierorazio PM, Tanagho YS, Bhayani SB, Kaouk JH, Rogers CG, Stifelman MD, Khalifeh A, Kumar R, Sivarajan G, Allaf ME.Outcomes and predictors of clinical T1 to pathological T3a tumor up-staging after robotic partial nephrectomy: a multi-institutional analysis.J Urol. 2013 Nov;190(5):1907-11. doi: 10.1016/j.juro.2013.06.014. Epub 2013 Jun 11.
This blog entry was written in part by Mohamad E. Allaf, MD, Associate Professor of Urology, Oncology, and Biomedical Engineering, and Director of Minimally Invasive and Robotic Surgery.
 Kutikov A, Fossett LK, Ramchandani P, Tomaszewski JE, Siegelman ES, Banner MP, Van Arsdalen KN, Wein AJ, Malkowicz SB.Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging.Urology. 2006 Oct;68(4):737-40.
 Rothman J, Egleston B, Wong YN, Iffrig K, Lebovitch S, Uzzo RG.Histopathological characteristics of localized renal cell carcinoma correlate with tumor size: a SEER analysis.J Urol. 2009 Jan;181(1):29-33; discussion 33-4. doi: 10.1016/j.juro.2008.09.009. Epub 2008 Nov 13.
 Thompson RH, Hill JR, Babayev Y, Cronin A, Kaag M, Kundu S, Bernstein M, Coleman J, Dalbagni G, Touijer K, Russo P.Metastatic renal cell carcinoma risk according to tumor size.J Urol. 2009 Jul;182(1):41-5. doi: 10.1016/j.juro.2009.02.128. Epub 2009 May 17.
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