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JU INSIGHT Pathological/Clinical Outcomes in a Large Intervention Cohort of Radiographically Cystic Renal Masses
By: Randall A. Lee, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Robert G. Uzzo, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Jordan Anaokar, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Ashanth Thomas, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Shuanzeng Wei, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Benjamin T. Ristau, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Andrew McIntosh, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Matthew Lee, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; David Y. T. Chen, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Richard E. Greenberg, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Rosalia Viterbo, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Marc C. Smaldone, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Andres Correa, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Jared Schober, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Kevin Ginsburg, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Laura Bukavina, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Diana Magee, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Nicole Uzzo, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Phyllis Parkansky, BS, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Karen Ruth, MS, Fox Chase Cancer Center, Philadelphia, Pennsylvania; Alexander Kutikov, MD, Fox Chase Cancer Center, Philadelphia, Pennsylvania | Posted on: 20 Apr 2023
Lee RA, Uzzo RG, Anaokar J, et al. Pathological and Clinical Outcomes in a Large Surveillance and Intervention Cohort of Radiographically Cystic Renal Masses. J Urol. 2023;209(4):686-693.
Study Need and Importance
Radiographically cystic renal masses are heterogeneous and may harbor cystic renal cell carcinoma (cRCC). The current literature highlights that pathologically verified cRCC exhibits indolent biology. Yet these data are limited by the fact that cRCC outcomes are largely indexed based on pathological, not radiographic, findings. Thus, distinguishing preoperatively between indolent cRCC and more biologically aggressive tumors remains a clinical challenge. To this end, we set out to examine our large institutional experience with renal masses classified on presentation as radiologically “cystic.”
What We Found
We identified 387 radiographically confirmed cystic lesions that underwent immediate intervention vs active surveillance (AS) ± delayed intervention. On pathological review, 23% demonstrated high-grade (HG) pathology, with cystic features explicitly reported in only 18% of pathology reports. Linear growth rate did not correlate with presence of HG pathology. Despite nearly1 in 4 patients harboring HG pathology at resection, AS in our cohort was extremely safe. Cancer-specific survival was indistinguishable between intervention and AS at 5 years (99% vs 100%, P = .2; see Figure).
Limitations
Limitations of our study include its retrospective design, and likely strong selection bias given our institution’s commitment to AS. Over the 20-year period, rates of AS varied as support for AS continued to emerge. Additionally, linear growth rates were calculated based on total lesion diameter rather than intralesional solid component, which may dictate aggressive biology in these masses.
Interpretation for Patient Care
Pathologically confirmed cRCC carries low oncologic risks; yet, radiographic and pathological characterization of cRCC markedly differs. Although 23% of radiographically cystic lesions that were resected in our cohort harbored HG pathology, our data continue to support the use of AS for patients with cRCC. To minimize overtreatment of cRCC, further study is needed to identify predictors of aggressive pathology in patients with radiographic cRCC.
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