PHILADELPHIA (February 4, 2019) — By diving deep into data about more than 1,300 past kidney cancer cases, Fox Chase Cancer Center researchers concluded that there is no compelling cancer-related reason to remove an entire kidney solely based on a tumor’s location in the hilum. Instead, other factors should provide more weight in risk-adapted decisions about whether to do a partial or a radical nephrectomy.
The report, entitled, “Renal Hilar Lesions: Biological Implications for Complex Partial Nephrectomy,” appeared in the January 2019 edition of the journal Urology. The study was conducted by Fox Chase’s urologic oncology team, and led by Robert G. Uzzo, MD, FACS, chair of the Department of Surgical Oncology.
Data showed that renal tumors on the hilum, which is where all the key blood vessels and drainage tubes of the kidneys live, exhibited no significant difference in malignancy rate, grade or stage compared with nonhilar lesions. Hilar lesions had an 87.2 percent chance of being malignant, while malignant nonhilar lesions appeared in 82.6 of cases. In addition, there was similarity in the rate of high-grade (aggressive) disease: 39.8 percent for hilar lesions versus 34.3 percent for nonhilar lesions. In a multivariate analysis, the researchers saw that increasing mass size rather than hilar location was the overriding determining factor for identifying aggressive hilar tumors.
“Renal lesions located near the hilum present a treatment quandary to the treating physician due to difficulties with preoperative biopsy and the technical complexity associated with a nephron-sparing procedure,” the group wrote. “The decision to pursue active surveillance or complex partial nephrectomy for hilar lesions is therefore hampered by the relative lack of information needed to evaluate complex surgical and oncologic tradeoffs.”
In response to the findings, the team recommended that differences in surgical risks, perioperative complications, surgical experience, and competing functional (renal and nonrenal) considerations be at the core of decision-making for addressing complex hilar lesions, tracking with recent American Urological Association (AUA) guidelines.
The AUA recommends that physicians take a risk-adapted approach for the treatment of localized renal masses, with special emphasis on the preoperative evaluation. This should include a detailed review of the patient's health status, diagnostic imaging, biopsy pathology if feasible and clinically meaningful, and the patient’s support network, the report said.
The study was supported in part by grant P30 CA006927from the National Cancer Institute, funding from the Betz Family Endowment for Cancer Research, and the Gitlin and Scheller, Foundations.