Extensive necrosis in renal cell carcinoma specimens: Potential clinical and prognostic implications

Background: Extensive necrosis is rare in primary renal cell carcinoma. Thi s finding may reflect the biological characteristics of the carcinoma and t herefore could be of prognostic and clinical value. Objectives: To assess the incidence of necrosis in renal cell carcinoma and its potential prognostic value. Methods: We conducted a consecutive retrospective study of 173 patients aft er radical nephrectomy for renal cell carcinoma. Clinical and pathological data were collected from hospital medical records and compiled into a compu terized database. Results: Extensive necrosis was found in 31 tumor specimens (17.9%). Univar iate analysis showed that the specimens with extensive necrosis were signif icantly larger and manifested more perirenal and venous extension than the tumors without necrosis. The size of the renal tumor was the only parameter that remained significant in multivariate analysis (P=0.0001). Overall dis ease-free survival did not differ significantly between patients with necro tic tumors and those without (68% and 66% respectively). Conclusions: The finding of extensive necrosis in renal cell carcinoma spec imens does not seem to be related to tumor biology but rather may reflect t he relation between size and vascularity of the tumor.