The incidence of renal cell carcinoma (RCC) has been increasing over the past few decades. Simultaneously, due to improved imaging, small renal masses at stage pT1 have been diagnosed more frequently. However, it is known that even small RCCs may recur and metastasize at a late point of time. This study aimed to identify easy-to-assess clinical and histopathological prognostic markers for long-term survival. We performed a retrospective analysis of patients who underwent surgical treatment of a pT1 RCC in a single centre between 1993 and 2007. The prognostic impact of clinical and histopathological parameters was investigated regarding recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Univariate Kaplan-Meier analysis and multivariate Cox regression analysis were performed using SPSS 23. Overall, 571 patients were included with a median follow-up of 111 months. Univariate analysis revealed that higher grading (p = 0.031) and stage pT1b (p < 0.001) were statistically significantly associated with worse RFS. Likewise, stage pT1b (p = 0.001) and grading G2/3 (p = 0.019) were significantly associated with shorter CSS. Multivariate analysis revealed that stage pT1b was the only predictor for reduced RFS (p = 0.001) and CSS (p = 0.009). Total nephrectomy (p = 0.024), and diabetes (p < 0.001) were significantly associated with reduced OS. Multivariate analysis revealed that multifocal tumours (p = 0.041) and diabetes (p < 0.001) were the best predictive factors for OS. The identified prognostic parameters may help to provide a risk-adapted after follow-up for patients with small renal tumours.
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