title: Prognostic variables to predict cancer-related death in incidental renal tumours.
abstract: OBJECTIVE
  To identify, in a large multicentre series of incidental renal tumours, the key factors that could predict cancer-related deaths, as such tumours have a better outcome than symptomatic tumours and selected patients are increasingly being included in watchful-waiting protocols.
  
  
  METHODS
  Data from 3912 patients were extracted from three international kidney-cancer databases. Age, gender, Eastern Cooperative Oncology Group (ECOG) performance status (PS), Tumour-Node-Metastasis (TNM) stage, tumour size, Fuhrman grade, and final pathology were recorded. Benign tumours and malignant lesions with incomplete information were excluded from final analysis.
  
  
  RESULTS
  The mean (SD) age of the patients was 60.6 (12.2) years and the mean tumour size 5.5 (3.5) cm. Most tumours were malignant (90.2%) and of low stage (T1-T2, 71.7%) and low grade (G1-G2, 72.4%). There were nodal and distant metastases in 5.7% and 13% of the patients. In all, 525 (14.4%) patients died from cancer; in this group, tumours were >4 cm in 88.2% and had nodal or distant metastases in 20.2% and 49.3%, respectively. Multivariable analysis showed that tumour size >4 cm, ECOG PS >or=1, TNM stage and Fuhrman grade were independent predictors of cancer-related death.
  
  
  CONCLUSIONS
  A significant proportion of incidental renal tumours can lead to the death of the patient. Standard prognostic variables for renal cell carcinoma appear to remain valid for this subset of patients. A watchful-waiting strategy should not be recommended if the tumour diameter is >4 cm, if biopsy confirms high-grade tumours, or if there is an impaired ECOG PS, or computed tomography findings suggest the presence of advanced T stage.
authors: Department of Urology, University of Rennes, Rennes, France.
authors: Karim
authors: K
authors: Bensalah
authors: Allan J
authors: AJ
authors: Pantuck
authors: Maxime
authors: M
authors: Crepel
authors: Grégory
authors: G
authors: Verhoest
authors: Arnaud
authors: A
authors: Méjean
authors: Antoine
authors: A
authors: Valéri
authors: Vincenzo
authors: V
authors: Ficarra
authors: Christian
authors: C
authors: Pfister
authors: Jean-Marie
authors: JM
authors: Ferrière
authors: Michel
authors: M
authors: Soulié
authors: Luca
authors: L
authors: Cindolo
authors: Alexandre
authors: A
authors: De La Taille
authors: Jacques
authors: J
authors: Tostain
authors: Denis
authors: D
authors: Chautard
authors: Luigi
authors: L
authors: Schips
authors: Richard
authors: R
authors: Zigeuner
authors: Claude C
authors: CC
authors: Abbou
authors: Bernard
authors: B
authors: Lobel
authors: Laurent
authors: L
authors: Salomon
authors: Eric
authors: E
authors: Lechevallier
authors: Jean-Luc
authors: JL
authors: Descotes
authors: Francois
authors: F
authors: Guillé
authors: Marc
authors: M
authors: Colombel
authors: Arie S
authors: AS
authors: Belldegrun
authors: Jean-Jacques
authors: JJ
authors: Patard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult