Abstract
Introduction
Small renal masses (SRMs) are often incidentally diagnosed, and a large proportion
are malignant. However, there is a paucity of data describing predictors of malignancy
in minority patients with SRMs. Thus, our goal was to examine clinical risk factors
associated with SRM malignant histology in patients undergoing partial nephrectomy
(PN) a diverse, urban academic center.
Materials and Methods
Patients with a SRM undergoing PN at a single institution between 2010 to 2018 were
reviewed. Demographic, clinical, and imaging characteristics were compared to pathology
results. Logistic regression was used to examine associations between demographic/clinical
variables for malignant and high-grade histology.
Results
In total, 331 patients who underwent PN for SRM were included. Of those, 264 (79.8%)
had malignant histology while 67 (20.2%) had benign histology. The proportions of
men and of current smokers were significantly higher among patients with malignant
histology. In multivariate models, non-Hispanic Black (NHB) patients had increased
odds of having malignant histology (OR 2.46, 95% CI: 1.01-5.99, P = .048) and current smokers (OR = 4.02; 95% CI 1.14-14.18, P = .031). Hispanic patients had a 3-fold increased risk of high-grade RCC (OR 3.06,
95% CI: 1.19-7.87, P = 0.02) compared to Non-Hispanic White patients.
Conclusion
In our population, male sex, smoking, and NHB race/ethnicity was associated with an
increased risk of malignancy in patients undergoing partial nephrectomy for SRM. Older
age and Hispanic race/ethnicity were associated with high grade RCC. Our results suggest
that urologists should exercise a higher level of vigilance in managing and treating
SRM among NHB and Hispanic patients.
Keywords
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References
- Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA: Cancer J Clin. 2018; 68: 394-424https://doi.org/10.3322/caac.21492
- Continued increase in incidence of renal cell carcinoma, especially in young patients and high grade disease: United States 2001 to 2010.J Urol. 2014; 191: 1665-1670https://doi.org/10.1016/j.juro.2013.12.046
- Renal cell cancer stage migration: analysis of the national cancer data base.Cancer. 2008; 113: 78-83https://doi.org/10.1002/cncr.23518
- Preoperatively misclassified, surgically removed benign renal masses: a systematic review of surgical series and United States population level burden estimate.J Urol. 2015; 193: 30-35https://doi.org/10.1016/j.juro.2014.07.102
- Solid renal tumors: an analysis of pathological features related to tumor size.J Urol. 2003; 170: 2217-2220https://doi.org/10.1097/01.ju.0000095475.12515.5e
- Association of prevalence of benign pathologic findings after partial nephrectomy with preoperative imaging patterns in the United States from 2007 to 2014.JAMA Surg. 2019; 154: 225-231https://doi.org/10.1001/jamasurg.2018.4602
- Risk prediction in the management of small renal masses.Curr Opin Urol. 2012; 22: 347-352https://doi.org/10.1097/MOU.0b013e328355ede9
- A preoperative prognostic nomogram for solid enhancing renal tumors 7 cm or less amenable to partial nephrectomy.J Urol. 2007; 178: 429-434https://doi.org/10.1016/j.juro.2007.03.106
- Predictors of locally advanced and metastatic disease in patients with small renal masses.BJU Int. 2012; 109: 1463-1467https://doi.org/10.1111/j.1464-410X.2011.10553.x
- Evaluating overall survival and competing risks of death in patients with localized renal cell carcinoma using a comprehensive nomogram.J Clin Oncol. 2010; 28: 311-317https://doi.org/10.1200/jco.2009.22.4816
- Clinical predictors of renal mass pathological features.BJU Int. 2011; 107: 735-740https://doi.org/10.1111/j.1464-410X.2010.09629.x
- Ethnic disparities in renal cell carcinoma: an analysis of Hispanic patients in a single-payer healthcare system.Int J Urol. 2017; 24: 765-770https://doi.org/10.1111/iju.13424
- Follow-up for clinically localized renal neoplasms: AUA guideline.J Urol. 2013; 190: 407-416https://doi.org/10.1016/j.juro.2013.04.121
- Democratizing information creation from health care data for quality improvement, research, and education-the Montefiore medical center experience.Acad Med. 2010; 85: 1362-1368https://doi.org/10.1097/ACM.0b013e3181df0f3b
- The international society of urological pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters.Am J Surg Pathol. 2013; 37: 1490-1504https://doi.org/10.1097/PAS.0b013e318299f0fb
- Epidemiology of renal cell carcinoma.Eur Urol. 2019; 75: 74-84https://doi.org/10.1016/j.eururo.2018.08.036
- Classification tree for the prediction of malignant disease and the prediction of non-diagnostic biopsies in patients with small renal masses.Can Urol Assoc J. 2019; 13: 115-119https://doi.org/10.5489/cuaj.5196
- Prevalence and predictors of benign lesions in renal masses smaller than 7 cm presumed to be renal cell carcinoma.Clin Genitourin Cancer. 2012; 10: 121-125https://doi.org/10.1016/j.clgc.2012.01.005
- Evaluation of anatomic and morphologic nomogram to predict malignant and high-grade disease in a cohort of patients with small renal masses.Urol Oncol. 2014; 32 (37.e17-23)https://doi.org/10.1016/j.urolonc.2013.03.003
- External validation of the RENAL nephrometry score nomogram for predicting high-grade renal cell carcinoma in solid, enhancing, and small renal masses.World J Urol. 2014; 32: 249-255https://doi.org/10.1007/s00345-013-1159-3
- Does overweight influence the prognosis of renal cell carcinoma? results of a multicenter study.Int J Urol. 2013; 20: 585-592https://doi.org/10.1111/iju.12000
- An epidemiologic and genomic investigation into the obesity paradox in renal cell carcinoma.J Natl Cancer Inst. 2013; 105: 1862-1870https://doi.org/10.1093/jnci/djt310
- New insights into the obesity paradox in renal cell carcinoma.Nat Rev Nephrol. 2020; 16: 253-254https://doi.org/10.1038/s41581-020-0264-y
- The impact of obesity and adiponectin signaling in patients with renal cell carcinoma: a potential mechanism for the "obesity paradox".PLoS One. 2017; 12e0171615https://doi.org/10.1371/journal.pone.0171615
- Transcriptomic signatures related to the obesity paradox in patients with clear cell renal cell carcinoma: a cohort study.Lancet Oncol. 2020; 21: 283-293https://doi.org/10.1016/s1470-2045(19)30797-1
- Racial disparity in renal cell carcinoma patient survival according to demographic and clinical characteristics.Cancer. 2013; 119: 388-394https://doi.org/10.1002/cncr.27690
- Racial disparities in renal cell carcinoma: a single-payer healthcare experience.Cancer Med. 2016; 5: 2101-2108https://doi.org/10.1002/cam4.755
- The effect of race and gender on the surgical management of the small renal mass.Urol Oncol. 2013; 31: 1794-1799https://doi.org/10.1016/j.urolonc.2012.05.005
- Racial disparities and preventive measures to renal cell carcinoma.Int J Environ Res Public Health. 2018; 15https://doi.org/10.3390/ijerph15061089
- The association of baseline health and gender with small renal mass pathology.Can J Urol. 2014; 21: 7271-7276
- Racial diversity among histology of renal cell carcinoma at an urban medical center.Clin Genitourin Cancer. 2021; 19: e166-e170https://doi.org/10.1016/j.clgc.2020.12.010
- Renal cell carcinoma health disparities in stage and mortality among American Indians/Alaska natives and Hispanic Americans: comparison of national cancer database and Arizona cancer registry data.Cancers (Basel). 2021; 13https://doi.org/10.3390/cancers13050990
Article info
Publication history
Published online: June 08, 2022
Accepted:
June 5,
2022
Received in revised form:
June 2,
2022
Received:
April 8,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
