A Comparison of Oncologic Outcomes after Nephrectomy in Kidney Cancer Patients with and without Preoperative Renal Mass Biopsy.

Objectives: The objective of this study is to examine the safety of percutaneous renal mass biopsy and compare the oncological outcomes between patients who had a renal biopsy prior to nephrectomy procedures and those who did not have a biopsy.

Methods: We evaluated a total of 145 patients who underwent nephrectomy for renal cancer between January 2017 and January 2021. Based on the pretreatment percutaneous renal mass biopsy, we categorized the patients into two groups: the biopsy (-) group and the biopsy (+) group. We performed a comparative analysis of the radiologic and histological characteristics of the tumors in all the groups. We also conducted an examination of the surgical margin outcomes in cases of partial nephrectomy between the two groups. In addition, we did an analysis of the overall survival (OS), recurrence-free survival (RFS), metastasis-free survival (MFS), and disease-free survival (DFS) between each group.

Results: Out of 145 patients meeting inclusion criteria, we analyzed 119 cases. The mean age and tumor diameter were 56.75±11.71 years and 53.77±23.99 mm, respectively. Operative time averaged 176.87±56.46 minutes, with a mean follow-up of 25.67±14.27 months (range: 8-60 months). Partial nephrectomy rates were 35.41% (biopsy (-)) and 43.47% (biopsy (+)), with left kidney tumors in 46/96 (biopsy (-)) and 16/23 (biopsy (+)) cases, respectively. Cystic and exophytic tumors varied significantly between groups (p=0.01 and p=0.03). During follow-up, 16 deaths occurred. Mean overall survival (OS) was 51.38±2.26 months. We noted local recurrence and metastatic progression in 4 and 7 patients, respectively, with lung metastases in all cases. RFS, MFS and DFS times averaged 57.94±1.00, 54.75±1.67, and 53.83±1.75 months, respectively. The biopsy (+) group showed a higher prevalence of papillary and chromophobe RCC subtypes. Pathological parameters and surgical outcomes were comparable between groups. OS, RFS, MFS, and DFS times did not significantly differ (p>0.05).

Conclusion: According to our findings, a percutaneous renal mass biopsy is a safe procedure. It can aid in the diagnostic evaluation of suspected renal masses and mitigate any adverse effects on oncological outcomes. Our opinion is that patients with suspected renal cancer can safely and successfully use routine percutaneous renal mass biopsy.