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2008 Annual Meeting Abstracts
The Impact Of Surgical Delay On Renal Mass Interval Growth Based On Preoperative Imaging And Final Pathologic Specimen
James Johannes, Raymond Pak, Deborah Glassman, Edouard Trabulsi, Dolores Shupp-Byrne, Leonard Gomella
Thomas Jefferson University, Philadelphia, PA
Introduction: Growth rates have been defined for renal masses. We examined renal mass sizes based on preoperative imaging and final pathologic specimen to define the impact of treatment delay on lesion size and pathological stage.
Methods: Patients with RCC treated laparoscopically at our institution since 1999 with CT or MRI imaging reports were included. Pre-operative imaging and pathologic sizes were compared. Time intervals between diagnosis and surgery were determined.
Results: 132 patients met inclusion criteria. Mean pre-operative tumor size and pathologic specimen were 5.1cm. Average delay from diagnosis to surgery was 14.3 weeks. By size 40% of lesions were larger, 53% smaller, and 7% unchanged. Pathologic stage was unchanged in 80% of patients (106/132). However, 10% (13/132) of patients were up-staged from a T1a to T1b or a T1b to T2. 10% of patients (13/132) were downstaged. Difference in treatment delay was significant between tumors that were upstaged (18.4 weeks) versus those downstaged (7.6 weeks) (p≤0.05). The average growth rates for tumors that enlarged (n=53) was 1.67 mm/week and 2.1 mm/week for upstaged tumors (n=13) .
Conclusions: Delay in treatment impacts candidates for partial nephrectomy as many patients crossed among pT1A, pT1B and pT2 disease. Higher growth rates in our series may reflect imaging underestimation or selection bias. Our data suggests treatment delay beyond 14 weeks may increase the risk of tumor upstaging.
Renal Mass Changes From Imaging To Patholigc Specimen | Radiographic Size (cm) | Pathologic Size (cm) | Growth (mm/week) | Treatment Delay (weeks) | Size (n=132)
(mean) | 5.1 | 5.1 | N/A | 14.3 | | Size - No Change (n=9) | 5.0 | 5.0 | N/A | 16.8 | | Size - Increase (n=53) | 4.4 | 5.8 | 1.67 | 20.3 | | Size - Decrease (n=70) | 5.5 | 4.6 | N/A | 9.4 | | TNM - No Change (n=106) | 5.0 | 5.0 | 0 | 14.6 | | TNM - upstage total (n=13) | 5.3 | 5.3 | 2.1 | 18.4 | | TNM - upstage T1a to T1b(n=9) | 3.2 | 5.1 | 1.2 | 22.1 | | TNM - upstage T1b to T2 (n=4) | 5.8 | 9.9 | 4.0 | 10.0 | | TNM- Downstage total | 6.2 | 4.2 | N/A | 7.6 |
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