Evaluation of Pathologic Predictors of Metastasis in Renal Cell Carcinoma – Emphasis on the Renal Sinus Microscopic Involvement
Vikas Mehta, Maria M Picken. Loyola University Medical Center, Maywood, IL; Ann & Robert H Lurie Children's Hospital, Chicago, IL
Background: Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and is responsible for over 13,000 deaths in the U.S. annually. The fatalities are largely due to distant metastasis. Common sites of metastases include the lung, liver, bone, brain, and adrenal gland, with case reports detailing the capacity of RCC to appear almost anywhere in the body. More than one organ system is often involved in the metastatic process. It is difficult to predict which patients will develop metastasis. The aim of the study was to study the clinico-pathological features that can help predict metastasis in RCC.
Design: We reviewed patients with metastatic RCC over a 20-yr period. The pathologic stage (pT) renal sinus involvement (RSI) and/or lymph node metastasis (LNM) were evaluated and correlated with the presence or absence and distibution of distant metastases.
Results: There were 191 patients with RCC and distant metastasis. There were 137 males and 54 females (M:F= 2.5:1). The age ranges from 18-85 (mean = 58 years). The most common site of metastasis was lungs followed by spine and long bones. Clear cell RCC was the most common subtype account for 111/191 (58%) of the cases. RSI was seen in 146/191 (76%) of cases. The pathological T stage breakdown was pT2=31(17%); pT3 =117(61%) and pT4 = 43 (22%). Pathological N stage breakdown was N1=107, N0 =49 and Nx = 35. The RSI was seen in 98/107(91%) cases with N1, 34/49(69%) cases with N0 and 14/35 (40%) cases with Nx stage. RSI showed a strong correlation with LNM (p value <0.0001). The average tumor size for cases with RSI was 10.2cm versus 8.8cm for cases without RSI.
Conclusions: Our data indicates that RSI is a strong predictor of LN and systemic metastases. Moreover, in N0 and NX patients RSI independently correlated with distal metastases, suggesting alterantive routes of cancer spread.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 142, Monday Morning