Long-term oncological outcomes of cystic renal cell carcinoma according to the Bosniak classification
- 30 Downloads
To evaluate the prognostic role of the Bosniak classification on the long-term oncological outcomes of cystic renal cell carcinomas.
Material and method
In a national multicentric retrospective study, we included patients treated surgically for localized cystic RCC from 2000 to 2010. Patients with a follow-up of less than 4 years, benign tumors, and ablative treatments were excluded. The primary outcome was disease-free survival.
152 patients met the inclusion criteria: Bosniak II (6%), III (53%), IV (41%), with a median follow-up of 61 (12–179) months. Characteristics of the population and the tumors were [median, (min–max)] age 57 (25–84) years old, tumor size 43 mm (20–280), RENAL score 7 (4–12), PADUA score 8 (5–14). Treatments were 55% partial nephrectomy, 45% radical nephrectomy, 74% open surgery, and 26% laparoscopy. In pathological report, cystic RCC were mainly of low grade (1–2, 77%) and low stage (pT1, 81%). The two main histological subtypes were conventional (56%) and papillary (23%) RCC. Staging at presentation and histological characteristics were similar between Bosniak III and IV, except for high grade which was more common in Bosniak IV (12 vs 36%, p < 0.01). The Bosniak classification was not predictive of the recurrence, as 5- and 10-year disease-free survival were similar in Bosniak III and IV (92% vs 92% and 84% vs 83%, p = 0.60).
The Bosniak classification is predictive of the risk of malignancy but not of the oncological prognosis. Regardless of the initial Bosniak categories, almost all cystic RCCs were of low stage/grade and had low long-term recurrence rate.
KeywordsRenal cell carcinoma Complex renal cyst Bosniak
RB had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Protocol/project development: Boissier, Bensalah. Data collection or management: Chkir. Chelly, Dariane, Khene, Giwerc, Allenet, Lefrancq, Gimel, Hetet. Data analysis: Boissier, Bensalah. Manuscript writing/editing: Boissier. Other (please specify briefly using 1 to 5 words): Critical revision of the manuscript for important intellectual content: Nouhaud, Bigot, Bernhard, Long, Gimel, Bodin, Ouzaid, Rioux-Leclercq, Correas, Albigès, Mejean.
Compliance with ethical standards
Conflict of interest
Authors reported no conflict of interest regarding this study.
Research involving human participants and/or animals
All included patients had locally signed a consent for the use of clinical and follow-up data for research purposes. The study was approved by the ethics committee of Association Francaise d’Urologie.
- 1.Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158(1):1–10Google Scholar
- 2.Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924Google Scholar
- 3.Steven Campbell MD, Robert G, Uzzo MD, Mohamad E, Allaf MD, Eric B, Bass MD, Jeffrey MPH, Cadeddu A, Anthony Chang MD, Peter MD, Clark E, Philip MD, Pierorazio M, Brian MD, Davis J, Ithaar MD, PhD, Derweesh H, Leo Giambarresi MD, Debra PhD, Gervais A, Susie MD, Hu L, Brian MD, Lane R, Leibovich BC (2017) American Urological Association - Renal Mass and Localized Renal Cancer: AUA Guideline [Internet]. http://www.auanet.org/guidelines/renal-mass-and-localized-renal-cancer-new. Accessed 6 June 2018
- 4.Warren KS, McFarlane J (2005) The Bosniak classification of renal cystic masses. BJU Int 95(7):939–942Google Scholar
- 5.Bosniak MA (1997) The use of the Bosniak classification system for renal cysts and cystic tumors. J Urol 157(5):1852–1853Google Scholar
- 6.Israel GM, Bosniak MA (2005) An update of the Bosniak renal cyst classification system. Urology 66(3):484–488Google Scholar
- 7.Israel GM, Bosniak MA (2003) Calcification in cystic renal masses: is it important in diagnosis? Radiology 226(1):47–52Google Scholar
- 8.Schoots IG, Zaccai K, Hunink MG, Verhagen PCMS (2017) Bosniak classification for complex renal cysts reevaluated: a systematic review. J Urol 198(1):12–21Google Scholar
- 9.Bielsa O, Lloreta J, Gelabert-Mas A (1998) Cystic renal cell carcinoma: pathological features, survival and implications for treatment. Br J Urol 82(1):16–20Google Scholar
- 10.Koga S, Nishikido M, Hayashi T, Matsuya F, Saito Y, Kanetake H (2000) Outcome of surgery in cystic renal cell carcinoma. Urology 56(1):67–70Google Scholar
- 11.Onishi T, Oishi Y, Goto H, Tomita M, Abe K, Sugaya S (2001) Cyst-associated renal cell carcinoma: clinicopathologic characteristics and evaluation of prognosis in 27 cases. Int J Urol Off J Jpn Urol Assoc 8(6):268–274Google Scholar
- 12.Nassir A, Jollimore J, Gupta R, Bell D, Norman R (2002) Multilocular cystic renal cell carcinoma: a series of 12 cases and review of the literature. Urology 60(3):421–427Google Scholar
- 13.Han K-R, Janzen NK, McWhorter VC, Kim HL, Pantuck AJ, Zisman A et al (2004) Cystic renal cell carcinoma: biology and clinical behavior. Urol Oncol 22(5):410–414Google Scholar
- 14.Webster WS, Thompson RH, Cheville JC, Lohse CM, Blute ML, Leibovich BC (2007) Surgical resection provides excellent outcomes for patients with cystic clear cell renal cell carcinoma. Urology 70(5):900–904 (discussion 904)Google Scholar
- 15.Donin NM, Mohan S, Pham H, Chandarana H, Doshi A, Deng F-M et al (2015) Clinicopathologic outcomes of cystic renal cell carcinoma. Clin Genitourin Cancer 13(1):67–70Google Scholar
- 16.Winters BR, Gore JL, Holt SK, Harper JD, Lin DW, Wright JL (2015) Cystic renal cell carcinoma carries an excellent prognosis regardless of tumor size. Urol Oncol 33(12):505.e9–505.e13Google Scholar
- 17.Nouhaud FX, Bernhard JC, Bigot P, Khene ZE, Audenet F, Lang H et al (2018) Contemporary assessment of the correlation between Bosniak classification and histological characteristics of surgically removed atypical renal cysts (UroCCR-12 study). World J Urol 36(10):1643–1649Google Scholar
- 18.Moch H (2010) Cystic renal tumors: new entities and novel concepts. Adv Anat Pathol 17(3):209–214Google Scholar
- 19.Foshat M, Eyzaguirre E (2017) Acquired cystic disease-associated renal cell carcinoma: review of pathogenesis, morphology, ancillary tests, and clinical features. Arch Pathol Lab Med 141(4):600–606Google Scholar
- 20.Williamson SR, Halat S, Eble JN, Grignon DJ, Lopez-Beltran A, Montironi R et al (2012) Multilocular cystic renal cell carcinoma: similarities and differences in immunoprofile compared with clear cell renal cell carcinoma. Am J Surg Pathol 36(10):1425–1433Google Scholar
- 21.Huber J, Winkler A, Jakobi H, Bruckner T, Roth W, Hallscheidt P et al (2014) Preoperative decision making for renal cell carcinoma: cystic morphology in cross-sectional imaging might predict lower malignant potential. Urol Oncol 32(1):37.e1–37.e6Google Scholar
- 22.Chandrasekar T, Ahmad AE, Fadaak K, Jhaveri K, Bhatt JR, Jewett MAS et al (2017) Natural history of complex renal cysts: clinical evidence supporting active surveillance. J Urol 199(3):633–640Google Scholar
- 23.Jhaveri K, Gupta P, Elmi A, Flor L, Moshonov H, Evans A et al (2013) Cystic renal cell carcinomas: do they grow, metastasize, or recur? Am J Roentgenol 201(2):W292–W296Google Scholar
- 24.Spaliviero M, Herts BR, Magi-Galluzzi C, Xu M, Desai MM, Kaouk JH et al (2005) Laparoscopic partial nephrectomy for cystic masses. J Urol 174(2):614–619Google Scholar
- 25.Pradere B, Peyronnet B, Delporte G, Manach Q, Khene Z-E, Moulin M et al (2018) Intraoperative cyst rupture at partial nephrectomy of cystic renal masses: does it increase the risk of recurrence? J Urol 200(6):1200–1206Google Scholar