Introduction to small renal tumours and prognostic indicators

In the last years, the widespread use of radiological imaging for abdominal symptoms not related to kidney cancer has been associated with a significant increase in the percentage of renal tumours incidentally detected at an asymptomatic stage. The term "small" renal tumours has changed his definitions during the years. Nowadays according to dimensional criteria, surgical indications and prognostic impact, small renal tumours should be defined as masses ≤4 cm in size. Classical preoperative variables influencing the decision-making process in the management of T1a renal tumours can be classified into patient-related and tumour-related factors. Age was an independent predictor of cancer-specific survival (CSS), with older patients having significantly worse survival. Accurate classification of the anatomical and topographic characteristics of small renal masses according to available nephrometry systems must be considered as a standard of quality of the preoperative evaluation of patients suitable for partial nephrectomy (PN). Renal tumour biopsies (RTBs) could be indicated in patients suitable for active surveillance or ablative treatments, in cases with other primary tumour, in those with prior renal lesions and or multiple synchronous tumours showing median diagnostic rate of 92%. Usually, small renal tumours have a good prognosis. Patient age, mode of presentation, nuclear grading, coagulative necrosis and histologic subtype can influence the prognosis of this subgroup of RCC. © 2016 IJS Publishing Group Limited.