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The aggressive potential of small renal cell carcinoma increases dramatically beyond a tumor diameter of 3 cm
Nowadays, we are faced with an increased number of small renal tumors (<4cm) which are detected mainly in asymptomatic older patients (>70years) [1]. Studies on the natural history of small renal tumors managed by surveillance have demonstrated a relatively small increase in diameter ranging from a mean 0.22 to 0.54cm per year [2]. Not surprisingly a surveillance strategy has recently been recommended for tumors of this type, at least in patients at a higher surgical risk. However, little is known about small renal tumors. This has to be taken in consideration for treatment choice. Right know we have no good clinical armamentarium to find out, if the tumor will influence patient health. At least 20% of them are benign [3]. On the other hand we have clearly shown that histopathologcal tumor characteristics implicating potential aggressive behavior rise dramatically with the clinical tumor size of 3cm. In tumors <3cm versus 3.1-4cm renal cell cancer, at least pT3a, high Fuhrman Grade G3/G4 and to find metastases were found in 76.8%, 10.9%, 4.7%, and 2.4% versus 82.4%, 35.7%, 25.5% and 8.4%, respectively [3]. Given the difficulty in measuring tumor diameters reliably by sequential imaging studies, the threshold for selecting patients for a surveillance strategy should be set well under this parameter. Bibliographic references: [1] Chow, W. H., Devesa, S. S.,
Warren, J. L. and Fraumeni, J. F., Jr.: Rising incidence of renal cell
cancer in the United States. JAMA, 281: 1628, 1999 [2] Volpe
A, Panzarella
T, Rendon
RA, Haider
MA, Kondylis
FI, Jewett
MA: The natural history of incidentally detected small renal
masses. Cancer. 15;100(4):738-45,
2004
Mesut Remzi Department of Urology, Medical University of Vienna, Vienna, Austria
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