Early ct assessment of patients after nephrectomy done due to poorly differentiated clear cell cancer
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Andrzej Gołubiński, Bartłomiej Gliniewicz, Artur Lemiński, Agata Kaliszczak, Andrzej Sikorski

Katedra i Klinika Urologii PAM w Szczecinie

summary

Introduction.

Renal cell cancer (RCC) is the most frequent kidney cancer. Despite increased detection rate, every third patient will have metastases in the time of diagnosis. Additional 30% of patients will have metastases after radical treatment. According to Mayo Scoring System the most important risk factors of RCC recurrence are stage and grade of the primary tumor. Proper risk of recurrence stratification enables to fit the best schema of radiological control. Usually it starts 6 months after removal of RCC with high risk of recurrence. It is of utmost importance to assess if earlier radiological examinations may help to detect early metastatic disease and gain better

treatment results.

Objectives.

To assess if early postoperative CT assessment may be useful in diagnosis of metastases in RCC disease.

Materials and methods.

28 consecutive patients (19 men and 9 women) after nephrectomy done due to poorly differentiated (G3 or G4) RCC were assessed. Medium age 60.7 (range 49 – 76). G3 tumors were found in 21 cases (pT1b-4; pT2-4; pT3a-9; pT3b-4), G4 tumors in 7 cases (pT1b-1; pT2-2; pT3a-4). All patients had CT scans of the abdomen and chest X-ray done just before surgery. Post-operative CT scans of the chest, abdomen and pelvis were done 3 and 12 months after nephrectomy.

Results.

3 months after surgery 16 patients (57%) had negative CT scans. In 12 cases (43%) the results were positive for metastases. Among them 9 patients (32,1%) had lymph nodes (LN) enlargement. In 2 cases positive LN coexisted with lung or bone lesions. Isolated bone or lung metastases were found in 1 (3.6%) and 2 (7.1%) cases, respectively. Oncological treatment was introduced in 6 patients (immunotherapy in 4 cases, radiotherapy – 1 case, bone lesion resection – 1 case). After 12 months CT scans were done in 26 (92.8%) patients. Two persons (7,1%) died because of disseminated RCC in 6th and 7th month after surgery. Negative CT scans were obtained from 13 (46.4%) patients, including 3 (10.7%) patients with negative previous CT scans. Enlarged LN were observed in 8 (28.6%) cases. In one case positive LN coexisted with lung lesions, in 2 cases with bone metastases. Isolated lung lesions were found in 4 (14.3%) patients. Disseminated metastases were present in one (3.6%) patient. According to CT findings oncological treatment was introduced in additional 4 cases (immunotherapy in 2 cases, lymphadenectomy – 1case, radiotherapy – 1 case). Other patients are still in a strict urological follow-up.

Conclusions.

The diagnosis of poorly differentiated RCC should necessitate early complex CT evaluation, with special emphasis on lungs.