RADICAL NEPHRECTOMY FOR RENAL-CELL CARCINOMA 30 MM OR LESS - LONG-TERM FOLLOW-UP RESULTS

Purpose: We investigated the clinical and pathological features, and l ong-term followup of patients treated with radical nephrectomy for ren al cell carcinoma of 30 mm. or smaller and a normal contralateral kidn ey. Materials and Methods: Between 1973 and 1993, 74 patients 29 to 83 years old (average age 60) underwent radical nephrectomy for renal ce ll carcinoma of 30 mm. or smaller. Average followup was 101 months (ra nge 10 to 236). Of the 74 tumors 21 were stage pT1, 36 stage pT2 and 1 2 stage pT3 (all 69 stage NO to NxMO), while 5 were stages pT1 to 3, N 1 or M1. A total of 27 patients died during followup. Of 11 patients w ho died of disease progression 5 had metastatic disease initially. Res ults: Overall survival rates were 73% at 5 years, 55% at 10 years and 38% at 20 years. Cancer-specific survival rates without the 5 patients with stage N1 or M1 disease were 91% at 5 years, and 80% at 10 and 20 years. For the group with nonmultifocal renal cell carcinoma, stage N O to Nx and/or MO, the cancer-specific survival rates were 93% at 5 ye ars, and 81% at 10 and 20 years. For the group with multifocal renal c ell carcinoma, stage NO to Nx and/or NIO, the cancer-specific survival rate was 75% at 5, 10 and 20 years. There was a significant survival difference between the nonmultifocal and multifocal renal cell carcino ma groups at 5 years (p<0.05) but not at 10 and 20 years. Conclusions: Small renal cell carcinoma is definitively not a benign disease and a tumor of 30 mm. or smaller does not mean there is no risk of metastat ic or multifocal disease.