Turk Uroloji Dergisi, vol.29, no.2, pp.154-158, 2003 (SCI-Expanded)
Introduction: Increased use of transabdominal sonography and computerized tomography for screening of intra-abdominal and retroperitoneal diseases has led to an increased incidence of the serendipitous detection of asymptomatic renal tumors. Greater than 20% of patients with localized renal cell carcinoma (RCC) present with disease progression after surgery. The risk of progression after radical nephrectomy depends on the stage and tumor size of the primary tumor(1-3). The objective of this study was to determine the effect of tumor size on progression time in patients with localized renal cell carcinoma (RCC) who had undergone radical nephrectomy. Material and Methods: Between July 1992 and April 2002, 69 patients who had undergone radical nephrectomy due to pathological stage PT1 and PT2 RCC were included into this study. We evaluated these patients according to their age, tumor size at pathological specimen, follow up time and progression time. Cut-off value of tumor size was considered as 70 mm and to compare the progression times between the two groups, chi-square test was used. Patients that showed progression were compared with the ones that didn't show progression using independent t test and p<0.05 was accepted as statistically significant. Results: Of 69 patients, progression was detected in 11 patients while 58 of them didn't show any progression. The values of all patients' age, follow-up period and tumor size were 59.39±12.36, 48.42±28.7 month and 82.05±37.6 mm respectively. Average tumor size of the patients who showed progression, was 77.84±36.77 mm. Our patients who didn't show any progression, had average 104.27±35.46 mm tumor size. Mean progression time of patients with progression was 34.27±18.51 months. There was no difference between the two groups by patient's age (p=0.903) and follow-up time (p=0.08). Statistically, significant difference was found in tumor size between the two groups (p=0.03) and the difference in progression time between the two groups was found much more prominent (p=0.0012). Conclusion: Recent interest in nephron sparing surgery for renal cell carcinoma with an anatomically and functionally normal opposite kidney has been stimulated by advances in renal imaging, improved surgical techniques, the increasing number of incidentally discovered renal cell carcinomas and good long-term survival in patients with a solitary kidney undergoing this mandatory treatment. There currently is controversy surrounding the role of nephron sparing surgery versus radical nephrectomy in the treatment of small renal cell carcinomas with suitable prognostic factors. Our results suggest that tumor size is an important prognostic factor in follow-up of the patients with renal cell carcinoma who had undergone radical nephrectomy.