We thank Guo and Liu for making these important considerations. As stated in our study,1 our aim was to reexamine surgically treated patients with renal cell carcinoma (RCC) with T1a renal tumors 0–2 cm to better elucidate the distribution of age, sex, histologic subtype, and Fuhrman grade, along with the rates of synchronous metastases, in a large contemporary population-based cohort (SEER 2002–2016). However, even if we know African Americans to be effectively subjected to higher rates of papillary tumors,2,3 further stratification according to race would have created too many details in this manuscript and would have probably made it difficult to consult for readers.
Moreover, we specifically decided to not focus on survival rates, as we have done in another recent study.4 Consequently, considering the presence of multiple primary cancers, the probability of developing a second malignancy, and survival rates according to node and distant metastases were not the main objectives of our manuscript.
Additionally, because the patients with metastatic disease (N1 or M1) represented a small group (n=56/13,364; 0.4%), we did not stratify our analyses according to metastatic site. This was also because in the SEER database this information is available only from 2010. Finally, regarding the last comment, Table 2 in our original article1 clearly shows that patients with sarcomatoid dedifferentiation are more likely to harbor metastatic disease (n=4/13,364; 13.8%), because multilocular cystic RCC showed virtual zero rate of synchronous metastases.
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.
Lipworth L, Morgans AK, Edwards TL, et al. Renal cell cancer histological subtype distribution differs by race and sex. BJU Int 2016;117:260–265.
Rosiello G, Palumbo C, Knipper S, et al. Histotype predicts the rate of lymph node invasion at nephrectomy in patients with nonmetastatic renal cell carcinoma. Urol Oncol 2020;38:537–544.
Rosiello G, Pecoraro A, Luzzago S, et al. Prognostic factors in patients with small renal masses: a comparison between <2 vs 2.1–4 cm renal cell carcinomas. Cancer Causes Control 2020;32:119–126.