Mode of presentation of XXXX provides prognostic information.

@entity1 @entity66 @entity5 @entity812 @entity797 @entity1358 @entity1442 @entity158 @entity8231 @entity3 @entity811
PURPOSE: Broadened applications of imaging modalities have increased the incidental detection of @entity1358 ( @entity1358 ) over the past decade. Previous small series have suggested a prognostic benefit for incidental presentation. This study utilizes a large contemporary @entity1 cohort to examine patterns of @entity1358 presentation and their clinical implications. MATERIALS AND METHODS: Retrospective analysis was performed on 721 @entity1 (260 @entity1 , 461 @entity1 ) who underwent 750 nephrectomies for treatment of @entity1358 between 7/1/89 and 12/31/97; 29 @entity1 required two operations for bilateral @entity1358 . Median age and follow-up were 63 years and 41 months, respectively. Indicators of symptomatic presentation included @entity812 , @entity812 , @entity811 , varicocele, constitutional symptoms, @entity8231 , and @entity158 related to @entity3 . Mode of presentation was compared with clinicopathologic parameters using Chi-square and t-test analyses. Survival analysis was performed using Kaplan-Meier estimates (log-rank test) and @entity797 regression modeling. RESULTS: Incidental and symptomatic presentation occurred in 57% and 42% of cases, respectively. When compared to incidental cases, symptomatic presentation was predominantly detected in younger @entity1 (mean age, 59 years; P < .001), in males (P < .04), and in @entity5 with conventional (clear cell) histology (P < .001), larger size (mean, 8 cm; P < .001), and non-organ confined pathology (P < .001). In univariate analysis, symptomatic cases had a more adverse disease-free (P < .0001) and disease-specific (P < .0001) survival. In multivariate analysis, mode of presentation was an independent predictor of @entity66 -specific survival (P < 0.005). CONCLUSIONS: Symptomatic presentation correlates with an aggressive histology and @entity1442 . Incidental @entity5 may be frequently detected in female and elderly @entity1 , as these groups traditionally seek general medical care more regularly. Mode of presentation can independently predict an adverse @entity1 outcome and should be included in @entity1358 -specific modeling systems.
