Serendipitous renal cell carcinoma in the post-CT era: continued evidence in improved outcomes.
OBJECTIVE
To compare patient and tumor characteristics, including survival data, between serendipitous and non-serendipitously discovered renal cell carcinoma (RCCA) in an era of more frequent use of CT scanning and ultrasonography.


METHODS
The Tumor Registry of the Audie L. Murphy VA Hospital in San Antonio, TX, was reviewed for new diagnoses or initial treatment of RCCA from January 1985 through December 1999. Records were evaluated as to whether the initial diagnosis of RCCA was made serendipitously. Prognostic and epidemiological variables, were collected and disease-specific and overall survival data were computed.


RESULTS
Of 257 patients with RCCA, 93 (36.2%) presented with serendipitously discovered tumors and 100 presented with metastases at diagnosis. Mean tumor size was smaller in the serendipitous group, compared both pathologically (6.74 cm vs. 4.49 cm, P < 0.0001) and by radiographic measurement (8.04 cm vs. 4.87 cm, P < 0.0001). Sixty-six (71%) of 93 serendipitously discovered tumors were Stage I at diagnosis, vs. only 30 (18.4%) of 163 non-serendipitous tumors (P < 0.0001). When non-serendipitous tumors with metastatic disease at presentation were excluded, the percentage of patients with Stage I disease was lower than for serendipitous tumors (46.8% vs. 71%, P = 0.004). Pathologically confirmed tumor stage was more favorable for serendipitously discovered tumors: 40 of 77 (60%) non-serendipitous tumors were <pT3, vs. 70 of 86 (81.4%) serendipitous tumors (P < 0.0001). Overall and disease-specific survival was better in the serendipitous group as well, with a 5-year disease-specific survival of 94%, contrasted with 35% in the non-serendipitous group (P < 0.0001).


CONCLUSIONS
The widespread use of CT scanning and ultrasonography has led to a continued increase in the serendipitous diagnosis of a significant number of all RCCA which are associated with significantly lower stage at diagnosis, and thus with significantly improved survival.
Leslie
Jeffrey A
JA
Division of Urology, and the Department of Pathology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
Prihoda
Tom
T
Thompson
Ian M
IM
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000556:secondary / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome