The relationship between tumor volume kidney volume ratio and prognostic factors in renal cell carcinoma

Engin Denizhan Demirkıran, The relationship between tumor volume kidney volume ratio and prognostic factors in renal cell carcinoma, Zonguldak Bülent Ecevit University Faculty of Medicine, Thesis in Urology, Zonguldak, 2019 Introduction: Renal cell carcinomas constitute 2-3% of adult cancers. The method used in staging is the TNM classification. The most important determinant of this classification is the largest diameter of the tumor. According to this classification, two different tumors with the same largest diameter are included in the same group and treated similarly, without taking into account the size of the kidneys to which they belong. The effect of tumor volume on every individual kidney is disregarded. In this study, we aimed to investigate the effect of tumor volume kidney volume ratio, which has not been previously evaluated in the literature, on prognosis and prognostic factors of renal cell carcinoma. Materials and Methods: In this study, the files of 232 patients who underwent radical nephrectomy due to renal tumor between 01.2005 and 08.2018 were examined. Patients were divided into groups with a tumor / kidney ratio of over 0.45 and below. The survival, clinical and pathological factors and prognosis of these groups were analyzed. Mann Whitney U, Pearson, Yates, Fisher chi-square and Wilcoxon tests were used in group comparisons. Survival analysis was calculated by Kaplan-Meier test. The factors affecting survival were evaluated by Cox regression analysis. Findings: The distribution of 151 patients included in the study was 44 female (29.1%) and 107 male (70.9%). The median tumor volume was 45,04 cm3 (1,24-1647,36) and the median kidney volume was 293,02 cm3 (13-2808). 41 (27.2%) of the patients were in T1a, 71 (47%) were in T1b, 21 (13.9%) were in T2a and 18 (11.9%) were in T2b stage. Tumor volume (p <0.001), T stage (p <0.001), renal vein involvement (p: 0.020), microvascular invasion (p: 0.001), tumor necrosis (p: 0.010), collecting system invasion (p: 0.003), surgical margin positivity (p: 0.020) was significantly higher in the high tumor / kidney volume ratio group. The tumor / kidney volume ratio was found to be increased as the T stage increased. The tumor / kidney volume ratio was found to be significantly higher in patients with pathologic poor prognostic factors. High tumor / renal volume ratio group had (88,607 ± 13,729) vii significantly lower cancer specific survival rates compared to the low tumor / kidney volume ratio group (152,348 ± 8,059) and similarly high tumor / renal volume ratio group showed a significantly lower overall survival (87,126 ± 12,933) compared to the low tumor / kidney volume ratio group (132,582 ± 7,492). Result: Tumor / kidney volume ratio; as a result of the analyzes, was shown to be an effective parameter in predicting many values reported as an independent prognostic factor. It has been shown that the use of tumor / kidney volume ratio value resulting from the inclusion of kidney volume in the calculation shows significant results in predicting the clinical and pathological factors that affect the prognosis. Keywords: Renal cell carcinoma, tumor volume, kidney volume, risk factors, prognosis