Prognostic Significance of Clinical, Angiographic and Histological Findings in Renal Carcinoma: A Study of 31 Cases

Abstract

The opportunities for preoperative assessments of prognosis were studied retrospectively in thirty-one cases of renal carcinoma submitted to angiography and conventional pericapsular nephrectomy. The angioarchitecture of the tumour vessels and the demarcation of the lesion were assessed from preoperative angiographs. The cases were divided into three malignancy groups: (1) low degree, regular angioarchitecture and clear delimitation; (2) high degree, irregular angioarchitecture and/or diffuse periphery; (3) moderate degree, other cases. A moderate or high degree of malignancy assessed angiographically and ESR > 40 mm/h indicated a poor prognosis with the risk of a short survival time. Angiographic grading of malignancy was compared with various histological gradings and seemed to be equally reliable as a prognostic criterion. High age among men was found to be unfavorable for the prognosis. Hematuria and a palpable tumour had no clear prognostic significance. The ESR was found to be a prognostic criterion but not the white blood cell count. Histological findings of growth outside the renal capsule gave an unfavourable prognosis. Tumour thrombus was of no prognostic importance. Histological invasion of the pelvis, on the other hand, indicated a poor prognosis. Prolific round-cell infiltration in the peripheral zone of the tumour indicated a better chance of survival. Tumour size, represented by the maximal diameter of the lesion, was not a reliable criterion for differentiating the cases in this series.