Tumour location as a predictor of benign disease in the management of renal masses
DOI:
https://doi.org/10.5489/cuaj.961Abstract
Objective: To investigate the association between tumour location
and the proportion of benign disease in renal masses presumed to
be renal cell carcinoma (RCC) preoperatively.
Methods: This Institutional Review Board approved study includes
196 patients who underwent surgical treatment for renal masses
<5 cm at our institution by a single surgeon between January 2002
and June 2009. Based on preoperative imaging, each mass was
designated as central (touching or encroaching upon the renal collecting
system and/or renal sinus) or peripheral. The association
between tumour location and benign pathology was determined
using univariate and multiple logistic regression, including tumour
size and patient sex in the model.
Results: The proportion of histologically confirmed benign disease
in this series was 11.2%. The proportion of benign disease by
location was 5.9% and 19.5% for central and peripheral masses,
respectively. The effect of location was found to have a significant
prognostic value (p = 0.0273) with an adjusted odds ratio of
3.51 (95% CI = 1.38-19.62) for the odds of a benign diagnosis in
peripheral compared to central tumours. Tumour size and patient
sex were not significant predictors of benign pathology (p = 0.483
and 0.191, respectively).
Conclusions: Peripherally located renal masses are more likely to
be benign than centrally located renal masses. This information
may be used when selecting strategies for the management of renal
masses presumed to be RCC.
Objectif : Étudier le lien entre l’emplacement de la tumeur et
le taux de maladie bénigne en présence de masse rénales qu’on
suppose être un hypernéphrome avant l’intervention chirurgicale.
Méthodologie : L’étude approuvée par le Conseil d’examen de
l’établissement comptait 196 patients qui ont subi un traitement
chirurgical en raison de masses rénales de < 5 cm; toutes les interventions
ont été effectuées par le même chirurgien entre janvier
2002 et juin 2009. Selon les images obtenues avant l’opération,
chaque masse était considérée comme étant centrale (touchant
ou envahissant le système collecteur et/ou le sinus rénal) ou périphérique.
Le lien entre l’emplacement de la tumeur et le caractère
bénin a été déterminé à l’aide de régressions logistiques univariées
et multivariées, dont la taille de la tumeur et le sexe du patient.
Résultats : La proportion de tumeurs bénignes confirmées par examen
histologique dans cette série était de 11,2 %. Le taux de
tumeurs bénignes en fonction de l’emplacement était de 5,9 % et
de 19,5 % pour les masses centrales et périphériques, respectivement.
L’emplacement s’est révélé avoir une valeur pronostique
significative (p = 0,0273), avec un rapport de cotes ajusté de 3,51
(IC à 95 % = 1,38 à 19,62) pour la probabilité d’un diagnostic de
tumeur bénigne en périphérie en comparaison avec un emplacement
central. La taille de la tumeur et le sexe du patient n’étaient
pas des facteurs de prédiction significatifs d’une pathologie bénigne
(p = 0,483 et 0,191, respectivement).
Conclusions : Les masses rénales en périphérie sont plus susceptibles
d’être bénignes que les masses rénales centrales. Ces données
peuvent être utiles au moment de choisir la stratégie de prise
en charge des masses rénales supposées être un hypernéphrome.
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