Comparison between small renal masses 0-2 cm vs. 2.1-4 cm in size: A population-based study

Angela Pecoraro, Marina Deuker, Giuseppe Rosiello, Franziska Stolzenbach, Stefano Luzzago, Zhe Tian, Shahrokh F. Shariat, Fred Saad, Alberto Briganti, Anil Kapoor, Cristian Fiori, Francesco Porpiglia, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review


Background: The NCCN guidelines recommend active surveillance (AS) as an option for the initial management of cT1a 0-2 cm renal lesions. However, data about comparison between renal cell carcinoma (RCC) 0-2 cm vs. 2.1-4 cm are scarce. Methods: Within the Surveillance, Epidemiology, and End Results database (2002–2016), 46,630 T1a NanyMany stage patients treated with nephrectomy were identified. Data were tabulated according to histological subtype, tumor grade (low [LG] vs. high [HG]), as well as age category and gender. Additionally, rates of synchronous metastases were quantified. Results: Overall, 69.3 vs. 74.1% clear cell, 21.4 vs. 17.6% papillary, 6.9 vs. 6.8% chromophobe, 2.0 vs. 1.1% sarcomatoid dedifferentiation, 0.2 vs. 0.2% collecting duct histological subtype were identified for respectively 0-2 cm and 2.1-4 cm RCCs. In both groups, advanced age was associated with higher rate of HG clear cell and HG papillary histological subtype. In 0-2 cm vs. 2.1-4 cm RCCs, 13.8% vs. 20.2% individuals operated on harbored HG tumors and were more prevalent in males. Lower synchronous metastases rates were recorded in 0-2 cm RCC and ranged from 0 in respectively multilocular cystic to 0.9% in HG papillary histological subtype. The highest synchronous metastases rates were recorded in sarcomatoid dedifferentiation histological subtype (13.8% and 9.7%) in both groups. Conclusions: Relative to 2.1-4 cm RCCs, 0-2 cm RCCs harbored lower rates of HG tumors, lower rates of aggressive variant histology and lower rates of synchronous metastases. The indications and demographics of patients selected for AS may be expanded in the future to include younger and healthier patients.

Original languageEnglish
Pages (from-to)239.e1-239.e7
JournalUrologic Oncology: Seminars and Original Investigations
Issue number4
Publication statusPublished - Apr 2021


  • Chromophobe
  • Clear cell
  • Kidney cancer
  • Papillary
  • SEER
  • Tumor grade

ASJC Scopus subject areas

  • Oncology
  • Urology


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