Pediatric Small Renal Masses: Can Tumor Size Predict Histology and the Potential for Nephron-sparing Surgery?

No AccessJournal of UrologyPediatric Urology1 Mar 2023Pediatric Small Renal Masses: Can Tumor Size Predict Histology and the Potential for Nephron-sparing Surgery?This article is commented on by the following:Editorial Comment Daniel S. Han, Jonathan P. Walker, Andrew Nicklawsky, Peter Boxley, N. Valeska Halstead, Michael Tonzi, Sarah L. Hecht, Alyse Staley, Megan Eguchi, Myles G. Cockburn, Jonathan P. Roach, Amanda F. Saltzman, and Nicholas G. Cost Daniel S. HanDaniel S. Han †Correspondence: Stanford University School of Medicine and Lucile Packard Children's Hospital, 750 Welch Rd, Suite 218, Palo Alto, CA 94304 telephone: 650-724-3332; E-mail Address: [email protected] Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California , Jonathan P. WalkerJonathan P. Walker University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee , Andrew NicklawskyAndrew Nicklawsky University of Colorado Cancer Center, Aurora, Colorado , Peter BoxleyPeter Boxley University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado , N. Valeska HalsteadN. Valeska Halstead University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado , Michael TonziMichael Tonzi University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee , Sarah L. HechtSarah L. Hecht Oregon Health and Sciences University, Portland, Oregon , Alyse StaleyAlyse Staley University of Colorado Cancer Center, Aurora, Colorado , Megan EguchiMegan Eguchi University of Colorado Cancer Center, Aurora, Colorado , Myles G. CockburnMyles G. Cockburn University of Southern California, Keck School of Medicine, Los Angeles, California , Jonathan P. RoachJonathan P. Roach Surgical Oncology Program of the Children's Hospital Colorado, Aurora, Colorado , Amanda F. SaltzmanAmanda F. Saltzman University of Kentucky College of Medicine, Lexington, Kentucky , and Nicholas G. CostNicholas G. Cost University of Colorado Cancer Center, Aurora, Colorado University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado Surgical Oncology Program of the Children's Hospital Colorado, Aurora, Colorado View All Author Informationhttps://doi.org/10.1097/JU.0000000000003092AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The majority of children with unilateral renal masses suspicious for malignancy undergo radical nephrectomy, while nephron-sparing surgery is reserved for select cases. We investigated the impact of tumor size on the probability of histology. We hypothesized that pediatric small renal masses are more likely benign or non-Wilms tumor, thus potentially appropriate for nephron-sparing surgery. Materials and Methods: The SEER (Surveillance, Epidemiology, and End Results) database was analyzed for patients aged 0-18 years diagnosed with a unilateral renal mass from 2000-2016. Statistical analysis was performed to help determine a tumor size cut point to predict Wilms tumor and assess the predictive value of tumor size on Wilms tumor histology. Additionally, a retrospective review was performed of patients 0-18 years old who underwent surgery for a unilateral renal mass at a single institution from 2005-2019. Statistical analysis was performed to assess the predictive value of tumor size on final histology. Results: From the SEER analysis, 2,016 patients were included. A total of 1,672 tumors (82.9%) were Wilms tumor. Analysis revealed 4 cm to be a suitable cut point to distinguish non-Wilms tumor. Tumors ≥4 cm were more likely Wilms tumor (OR 2.67, P ≤ .001), but this was driven by the statistical significance in children 5-9 years old. From the institutional analysis, 134 patients were included. Ninety-seven tumors (72.3%) were Wilms tumor. Tumors ≥4 cm had higher odds of being Wilms tumor (OR 30.85, P = .001), malignant (OR 6.75, P = .005), and having radical nephrectomy-appropriate histology (OR 46.79, P < .001). Conclusions: The probability that a pediatric unilateral renal mass is Wilms tumor increases with tumor size. Four centimeters is a logical cut point to start the conversation around defining pediatric small renal masses and may help predict nephron-sparing surgery-appropriate histology. References 1. . Renal tumors of childhood: radiologic-pathologic correlation part 2. The 2nd decade: from the radiologic pathology archives. Radiographics. 2017; 37(5):1538-1558. Crossref, Medline, Google Scholar 2. . 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Conflict of Interest: AFS: Ethicon. The remaining Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. 14-1758). Author Contributions: Acquisition of the data: DSH, JPW, PB, SLH, NGC; analysis of the data: DSH, JPW, AN, PB, NVH, MT, SLH, AS, ME, MGC, NGC; critical revision of the work: DSH, JPW, AN, NVH, MT, SLH, AS, ME, MGC, JPR, AFS, NGC; design of the work: DSH, JPW, SLH, JPR, AFS, NGC; drafting of the work: DSH, JPW, AN, PB, NGC; interpretation of data: DSH, JPW, AN, NVH, MT, SLH, AS, ME, MGC, NGC. All Authors approve of the final version to be published and agree to be accountable for all aspects of the work. See Editorial on page 464. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byOst M and Ayyash O (2023) Extended Lymph Node Sampling During Surgery for Pediatric Renal Tumors Concerning for Malignancy: Balancing Safety and NecessityJournal of Urology, VOL. 209, NO. 6, (1066-1067), Online publication date: 1-Jun-2023.Lorenzo A (2022) Size Matters, at Least Sometimes…Journal of Urology, VOL. 209, NO. 3, (464-466), Online publication date: 1-Mar-2023.Wan J (2022) This Month in Pediatric UrologyJournal of Urology, VOL. 209, NO. 3, (459-459), Online publication date: 1-Mar-2023.Related articlesJournal of Urology15 Dec 2022Editorial Comment Volume 209Issue 3March 2023Page: 582-590Supplementary Materials Peer Review Report Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Keywordscarcinoma, renal cellWilms tumormedical oncologynephrectomysurgical oncologyMetricsAuthor Information Daniel S. Han Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California †Correspondence: Stanford University School of Medicine and Lucile Packard Children's Hospital, 750 Welch Rd, Suite 218, Palo Alto, CA 94304 telephone: 650-724-3332; E-mail Address: [email protected] Co-first authors. More articles by this author Jonathan P. Walker University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee Co-first authors. More articles by this author Andrew Nicklawsky University of Colorado Cancer Center, Aurora, Colorado More articles by this author Peter Boxley University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado More articles by this author N. Valeska Halstead University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado More articles by this author Michael Tonzi University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee More articles by this author Sarah L. Hecht Oregon Health and Sciences University, Portland, Oregon More articles by this author Alyse Staley University of Colorado Cancer Center, Aurora, Colorado More articles by this author Megan Eguchi University of Colorado Cancer Center, Aurora, Colorado More articles by this author Myles G. Cockburn University of Southern California, Keck School of Medicine, Los Angeles, California More articles by this author Jonathan P. Roach Surgical Oncology Program of the Children's Hospital Colorado, Aurora, Colorado More articles by this author Amanda F. Saltzman University of Kentucky College of Medicine, Lexington, Kentucky More articles by this author Nicholas G. Cost University of Colorado Cancer Center, Aurora, Colorado University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado Surgical Oncology Program of the Children's Hospital Colorado, Aurora, Colorado More articles by this author Expand All Support: This work was supported in part by the Population Health Shared Resource of the University of Colorado Cancer Center funded by the National Cancer Institute at the National Institutes of Health (P30CA046934). Conflict of Interest: AFS: Ethicon. The remaining Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. 14-1758). Author Contributions: Acquisition of the data: DSH, JPW, PB, SLH, NGC; analysis of the data: DSH, JPW, AN, PB, NVH, MT, SLH, AS, ME, MGC, NGC; critical revision of the work: DSH, JPW, AN, NVH, MT, SLH, AS, ME, MGC, JPR, AFS, NGC; design of the work: DSH, JPW, SLH, JPR, AFS, NGC; drafting of the work: DSH, JPW, AN, PB, NGC; interpretation of data: DSH, JPW, AN, NVH, MT, SLH, AS, ME, MGC, NGC. All Authors approve of the final version to be published and agree to be accountable for all aspects of the work. See Editorial on page 464. Advertisement PDF downloadLoading ...