Incidental and symptomatic renal tumors: impact on patient survival

CONTEXT: Renal cell carcinoma is the third most frequent genitourinary neoplasia, and there is currently an increase in the incidental diagnosis of tumors confined to the kidneys. OBJECTIVE: To study the survival of patients with incidental and symptomatic renal tumors who have undergone nephrectomy.DESIGN: Retrospective. SETTING: Hospital Sírio Libanês and Beneficência Portuguesa de São Paulo. PARTICIPANTS: 115 patients with diagnosis of renal cell carcinoma, operated on by the same group of surgeons and evaluated by a single pathologist. MAIN MEASUREMENTS: Sex, age and diagnosis method, analyzed in two groups, according to the tumor diagnosis: Group 1 with incidental diagnosis and Group 2 with symptomatic tumors. The anatomopathological characteristics and patient survival in both groups were evaluated. A statistical analysis was performed using the Student t, chi-squared, log rank and Kaplan-Meyer tests. RESULTS: Among the studied patients, 59(51 percent) had an incidental diagnosis, with 78 percent diagnosed by ultrasonography, 20 percent by computerized tomography scan and 2 percent during surgeries; 56 patients (49 percent) were symptomatic. Tumor locations were equally distributed between the two kidneys, and the surgery was conservative for 24 percent of the incidental and 9 percent of the symptomatic group. In the incidental group only one patient had tumor progression and there was no death, while in the symptomatic group there were 5 progressions and 10 deaths. The 5-year specific cancer-free survival was 100 percent in the incidental and 80 percent in the symptomatic group (p = 0.001) while the disease-free rate was 98 percent in the incidental and 62 percent in the symptomatic group (p < 0001). CONCLUSION: Incidental renal tumor diagnosis offers better prognosis, providing longer disease-free survival

Adenocarcinoma renal: análise da invasäo vascular microscópica como fator prognóstico em pacientes submetidos a tratamento cirúrgico / Renal adenocarcinoma: analysis of microscopic vascular invasion as prognostic factor in patients submitted to surgical treatment

O carcinoma de células renais constitui-se numa patologia cujo comportamento clínico é muitas vezes imprevisível, onde a pesquisa de fatores prognósticos toma-se de grande valia. Este estudo retrospectivo procurou analisar a importância da invasão celular microscópica na progressão da doença e sobrevida dos pacientes submetidos a tratamento cirúrgico, correlacionando-a com outros parâmetros prognósticos. Foram analisados 95 pacientes, com idade entre 8 e 81 anos (média 59 anos), portadores de adenocarcinoma renal clinicamente localizado, submetidos a nefrectomia radical e/ou cirurgia renal conservadora com seguimento médio de 33 meses. Estudou-se, através de análise univariada e multivariada, o impacto causado pela presença de invasão microvascular na evolução clínica da doença, correlacionando-a com a extensão do tumor, o grau nuclear e o tipo celular. Observou-se presença de invasão vascular microscópica em 24 pacientes (25 por cento), dos quais 50 por cento desenvolveram progressão da doença. Dentre os 71 pacientes sem invasão microvascular, somente quatro (5,6 por cento) apresentaram progressão. Quando se correlacionou a invasão microvascular com os demais parâmetros histológicos, verificou-se associação estatística significante (p