Introduction and Objectives
Histological finding correlates with tumor grow, biological activity and could be essential for the patient future. We have tried to confirm relationship between the histological presence of the tumor necrosis and patient's prognosis.
Material and Methods
Retrospective analysis of the histological finding of the renal cancers removed by total or partial nephrectomies since 2001 to 2005 was carried out. Histological type, tumor necrosis presence, tumor size, signs of the sarcomatoid transformation and nuclear grade according to the Fuhrman's grade were focuses of our interest. The followup was 4 to 8 years. We have evaluated progression disease rate and censored death due to cancer generalization.
Overall 228 renal cancers were removed, tumor necrosis was found in 61 patients (26.8%) – 53 patients with clear cell cancer (86.9%), 8 patients with papillary cancer (13.1%). Tumor size in this group was from 30 mm to 170 mm, median 70 mm. Tumor stage: pT1a in 5 pts (8.3%), pT1b in 16 pts (26.3%), pT2 in 11 pts (18%), pT3a in 14 pts (22.9%), pT3b in 14 pts (22.9%), pT3c in 1pt (1.6%), pT4 in 0 pts.(0%). N+ was found in 20 pts (32.8%), N0 in 41 pts (67.2%), M+ was confirmed in 17 pts (27.9%), M0 in 44 pts (72.1%). Nuclear grade GI was in 0 pts, GII in 6 pts (9.8%), GIII in 33pts (54.1%), GIV in 22 pts (36.1%). Overall 39 pts (63.9%) from these 61 pts have died in median 8 months after nephrectomy. Simultaneous presence of the tumor necrosis and sarcomatoid transformation were confirmed in 6 pts, all of them have died in median 6.5 months after surgery.
Tumor necrosis is serious negative prognostic factor. Tumor necrosis can be found even in small asymptomatic tumors. It is always indicator of the fast and aggressive tumor grow. Simultaneous presence of the tumor necrosis and sarcomatoid transformation are always signs of the high malignant potency of the renal cancer.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.