[Clinicopathologic features of renal cell carcinoma incidentally detected through radiological studies].

OBJECTIVES: To evaluate the reason for diagnosis of renal cell carcinoma and its variation over the years in Radiology 1 and Urology 1 departments of the Asturias Central Universitary Hospital (HUCA) comparing periods 1970-1995 and 1996-2005 and determine whether incidental findings may explain in an independent the prognosis of these tumors or it is dependent on its clinicopathologic characteristics.

MATERIAL AND METHODS: We conducted retrospectively, an exhaustive review of medical records of 373 renal cell carcinoma patients that underwent surgical resection during the period 1970-2005, collecting data according to a set protocol.

RESULTS: Of the 373 tumors in our series, 146 (39,1%) were diagnosed according to our criteria incidentally, while 227 (60,9%) were diagnosed due to clinical suspicion of a tumor presence. We observed a significant increase in the number of tumors incidentally diagnosed in the second period, when we performed the counting distributing these patients into two groups, firstly those diagnosed between the years 1970-1995 and, secondly, those diagnosed between 1996-2005. We found metastasis, microvascular invasion of surgical piece and treatment of the recurrence as independent factors for specific cancer survival, while nuclear grade, the presence of lymphadenopathies and T3 stage were found as independent factors for recurrence.

CONCLUSIONS: Classically renal cell carcinoma was diagnosed when local symptoms were present (hematuria and back pain, were the most common), symptoms associated with metastasis, or the expression of a paraneoplastic syndrome. The discovery of asymptomatic renal cell carcinomas has dramatically increased, since the widespread use of ultrasound and computed tomography (CT) in the study of abdominal pathology. It is worth mentioning that, in our study, although patients diagnosed with incidental tumors had a longer time free to recurrence and survival, however, the presence of clinic was not an independent risk factor for recurrence or cancer-specific survival.