Re: Pecoraro A, Rosiello G, Luzzago S, et al. Small renal masses with tumor size 0 to 2 cm: a SEER-based study and validation of NCCN Guidelines. J Natl Compr Canc Netw 2020;18(10):1340–1347.
With considerable interest, we read the article by Pecoraro et al1 titled “Small Renal Masses With Tumor Size 0 to 2 cm: A SEER-Based Study and Validation of NCCN Guidelines.” The authors summarized the characteristics of T1a 0- to 2-cm renal cell carcinoma (RCC). It deals with a significant clinical issue. As such, there are a few points that we would like to bring up.
First, patients diagnosed with RCC were included in this study, but multiple primary cancers were not excluded. However, another SEER-based study showed that patients with RCC were at a significantly higher risk of developing a second malignancy, which may affect patients' survival.2
Second, the patient’s baseline characteristics did not include race, as shown in Table 1 of the study.1 A previous study suggested that African American patients had roughly 3 times higher rates of papillary RCC across disease stages than non–African American patients.3
Finally, the prognosis of RCC with lymph node metastasis is different from that with distant metastases.4 It would be more worthwhile to stratify patients according to the site of metastasis; in this way, readers could easily see which histologic subtype is more likely to have distant metastasis, which has more impact on survival outcomes.
Pecoraro A, Rosiello G, Luzzago S, et al. Small renal masses with tumor size 0 to 2 cm: a SEER-based study and validation of NCCN Guidelines. J Natl Compr Canc Netw 2020;18:1340–1347.
Chakraborty S, Tarantolo SR, Batra SK, et al. Incidence and prognostic significance of second primary cancers in renal cell carcinoma. Am J Clin Oncol 2013;36:132–142.
Qi P, Tsivian M, Abern MR, et al. Clinicopathological characteristics and outcomes of surgically excised renal masses in African Americans. Urol Oncol 2014;32:555–560.
Abdel-Rahman O. Clinical correlates and prognostic value of different metastatic sites in metastatic renal cell carcinoma. Future Oncol 2017;13:1967–1980.