Changing prognosis of renal cell carcinoma: a single-centre experience over 25 years (original) (raw)

Clinico-pathological analysis of renal cell carcinoma demonstrates decreasing tumour grade over a 17-year period

Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2014

Renal cell carcinoma (RCC) represents about 3% of adult malignancies in Ireland. Worldwide there is a reported increasing incidence and recent studies report a stage migration towards smaller tumours. We assess the clinico-pathological features and survival of patients with RCC in a surgically treated cohort. A retrospective analysis of all nephrectomies carried out between 1995 and 2012 was carried out in an Irish tertiary referral university hospital. Data recorded included patient demographics, size of tumour, tumour-node-metastasis (TNM) classification, operative details and final pathology. The data were divided into 3 equal consecutive time periods for comparison purposes: Group 1 (1995-2000), Group 2 (2001-2006) and Group 3 (2007-2012). Survival data were verified with the National Cancer Registry of Ireland. In total, 507 patients underwent nephrectomies in the study period. The median tumour size was 5.8 cm (range: 1.2-20 cm) and there was no statistical reduction in size o...

Prognostic Significance of Tumour Size in Patients after Tumour Nephrectomy for Localised Renal Cell Carcinoma

European Urology, 2004

Objectives: Staging of the primary tumour is accepted as the most important prognostic factor in organ confined renal cell carcinoma. Methods: The outcome of 286 patients with non-metastatic RCC treated by radical nephrectomy at our institution between 1968 and 1992 was evaluated retrospectively. The median follow-up was 114 AE 62.6 months. In T1/T2 tumours, the validity of tumour size cutoff points for predicting survival outcome was tested. Results: According to the 1997 TNM classification, 168 patients (59%) showed pathological stage T1 (72 stage T1a, 96 stage T1b), 30 (10%) showed stage T2, 84 patients (29%) demonstrated T3 tumours (53 stage T3a, 31 stage T3b), and 4 patients (2%) presented with T4 tumours. The median survival estimated by Kaplan-Meier analysis for T1a, T1b, T2, T3a, T3b and T4 tumours was over 300 months, 187.0 AE 32.76; 177.0 AE 1.21; 121.0 AE 2.57; 124.0 AE 11.82 and 52.0 AE 18.38 months, respectively. Regarding survival in T1/T2 tumours Cox regression analysis yielded the highest significance level for a tumour size cutoff point at 4 cm (p ¼ 0.003; 95%CI 1.511-6.991), but no prognostic value for a cutoff point at 7 cm (T1 vs. T2) (p ¼ 0.375; 95%CI 0.655-3.071). Conclusions: Tumour size is an important prognostic factor in patients with organ confined RCC. The recently specified new cutoff point of 4 cm for T1a/T1b tumours is feasible for separating groups with different survival after tumour nephrectomy and should be considered as the new boundary between T1 and T2 stages. Hence, a more accurate prediction of prognostic differences between these groups should be possible.

Survival And Progression After Radical Nephrectomy In A Cohort Of Non-Metastatic Renal Cell Carcinoma Treated With Curative Intent

Journal of Ayub Medical College, Abbottabad : JAMC, 2019

BACKGROUND Radical nephrectomy (RN) is a standard treatment of cure for non-metastatic renal cell carcinoma (NMRCC). Long-term outcome data are limited for Pakistani population. Our aim was to assess the long-term outcomes of RCC treated with curative intent with radical nephrectomy (RN) and to study the 5 & 10years survival outcomes in patients with NMRCC who underwent radical nephrectomy. METHODS This is a retrospective review and analysis of the data between December 2006 and February 2017. We included all the adult patients (age ≥18 years) with NMRCC from both genders irrespective of their histologic subtypes who underwent radical nephrectomy (RN) with a curative intent. The data was analysed for overall survival and recurrence rates at 5- and 10-years using Kaplan-Meier survival analysis. Multivariate analysis was performed using Cox-regression to identify risk factors associated with poor overall outcome in terms of recurrence and mortality. RESULTS Three hundred and forty-fou...

Impact of Hospital Nephrectomy Volume on Intermediate to Long-term Survival in Renal Cell Carcinoma

BJU International

To evaluate the relationship between hospital volume and intermediate and long-term patient survival for patients undergoing nephrectomy for renal cell carcinoma (RCC). PATIENTS & METHODS Adult RCC patients treated with nephrectomy between 2000 and 2010 were identified from the English Hospital Episode Statistics and National Cancer Data Repository. Patients with nodal or metastatic disease were excluded. Hospitals were categorised into low (<20/yr), medium (20-39/yr) and high (40/yr) volume based on annual cases of RCC nephrectomy. Multivariable Cox regressions were used to calculate hazard ratios for all-cause mortality by hospital volume, adjusting for patient, tumour and surgical characteristics. We assessed conditional survival over three follow-up periods: short (30d-1yr), intermediate (1-3yr) and long (3-5yr). We additionally explored whether associations between volume and outcomes varied by tumour stage.

Age at diagnosis is a determinant factor of renal cell carcinoma-specific survival in patients treated with nephrectomy

Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2008

Based on combined data for 4880 patients, 2 previous studies reported that advanced age is a predictor of increased renal cell carcinoma-specific mortality (RCC-SM). We explored the effect of age in cubic spline analyses to identify the age groups with the most elevated risk for renal cell carcinoma (RCC). Our study included 3595 patients from 14 European centres who had partial or radical nephrectomies. We used the Kaplan-Meier method to compile life tables, and we performed Cox regression analyses to assess RCC-SM. Covariates included age at diagnosis, sex, TNM (tumour, node, metastasis) stage, tumour size, Fuhrman grade, symptom classification and histological subtype. Age ranged from 10 to 89 (mean 63, median 67) years. The median duration of follow-up was 2.9 years. The median survival for the cohort was 13.4 years. Stage distribution was as follows: 1915 patients (53.3%) had stage I disease, 388 (10.8%) had stage II, 895 (24.9%) had stage III and 397 (11.0%) had stage IV disea...

Prognostic factors for renal cell carcinoma: Trakya University experience from Turkey

European Journal of Cancer Care, 2010

The purpose of the present study is to evaluate the prognostic factors of patients with renal cell carcinoma. The treatment results such as distant metastasis-free survival and overall survival of 59 previously untreated patients were retrospectively analysed. Median follow-up was 17.5 months (3.8-88.5 months). Overall survival was 22.4 months (3-87 months). Distant metastasis developed in 35 (59%) patients. The Eastern Cooperative Oncology Group (ECOG) performance status (P = 0.022), tumour size (P = 0.025) and lymphatic invasion (P < 0.0001) were significantly effective prognostic factors for distant metastasis-free survival on multivariate analysis. Related to overall survival, gender (P = 0.025), ECOG performance status (P = 0.027), nuclear grade (P = 0.002), tumour size (P = 0.029), T stage (P = 0.044), nodal involvement (P = 0.003), surgical margin (P = 0.046), renal sinus invasion (P < 0.0001), perineural growth (P = 0.001) and lymphatic invasion (P < 0.0001) were significant prognostic factors on univariate analysis. Gender (P = 0.008), ECOG performance status (P = 0.027), tumour size (P = 0.025) and lymphatic invasion (P < 0.0001) retained their significance on multivariate analysis. We concluded that the most important prognostic factors for patients with renal cell carcinomas are ECOG performance status, tumour size and lymphatic invasion.

Comparison of oncologic outcomes between elective partial and radical nephrectomy in patients with renal cell carcinoma in CT1B stadium

Vojnosanitetski pregled, 2021

Background/Aim. In renal cell carcinoma (RCC), the choice of surgical technique, radical (RN) or partial nephrectomy (PN), is still center-dependent because there are still no absolute recommendations for this approach. The aim of this study was to analyze the oncological aspects, time until recurrent disease appears, and cancer-specific survival in patients with RCC in T1bN0?0 stadium depending on the type of surgical procedure, PN or RN technique. Methods. In a clinical observational study, data of 154 patients operated at the Clinic for Urology, Military Medical Academy, Belgrade, Serbia with a mean follow-up period of no less than five years were analyzed. Patients were divided into two groups; a group of patients with RN and a group of patients with PN. The inclusion criteria were: renal tumors 4?7 cm, histopathological confirmation of RCC, absence of metastasis, and normal serum creatinine. Exclusion criteria included: the presence of other malignancies, solitary functional ki...

Postoperative and Mid-term Outcomes of Unclassified Renal Cell Carcinoma

Üroonkoloji bülteni, 2021

Objective: To present the postoperative and oncological outcomes of patients diagnosed with unclassified renal cell carcinoma (uRCC). Materials and Methods: Radiological and pathological data of patients who underwent radical nephrectomy for renal tumour diagnosed with uRCC according to histopathologic evaluation were investigated between 2006 and 2013. Follow-up data, such as metastasis-free and overall survivals, were also evaluated. Patients' characteristics and data were compared between localised tumour (T1-T2) and locally invasive tumour (T3-T4) groups and metastasis positive and negative groups during follow-up, separately. Results: A total of 17 patients participated in the study, wherein 7 had adrenalectomy in addition to radical nephrectomy and 3 had lymph node dissection. The mean tumour diameter was 91.9±44 mm (30-200 mm), and seven patients were pathologically T3a, two were T3b and one patient had T4 tumour, whereas eight had Fuhrman grade 4 and five had Fuhrman grade 3 tumours. Pathologically, seven patients had tumours with sarcomatoid features, whereas four had microvascular invasion and seven had renal sinus invasion. T-stage correlated with renal sinus invasion and was identified as an important factor in metastasis progression. The overall survival time was observed to be low in locally invasive and metastasis positive groups. Nevertheless, differences were not statistically significant. In the investigation of factors affecting metastasis development, microvascular invasion and renal sinus invasion were significant. Conclusion: The study revealed more aggressive nature (advanced stage, bigger tumour, more aggressive histopathological features and more metastasis and shorter survival on follow-up) of uRCC tumours, even without obtaining statistically significant differences.

Changing the Stage, Grade and Histological Subtypes of Renal Cell Carcinomas during 10 Years Period

Prague medical report

Renal cell carcinomas (RCCs) account 80-85% of all primary renal neoplasms and originate from the renal cortex. The patients who underwent radical or partial nephrectomy for renal tumour in our unit between January 2005 and 2015 were evaluated retrospectively. The patients were divided into two groups; group 1 includes patients who were treated between January 2005 and December 2009, group 2 those from January 2010 to 2015. There were 103 patients in group 1. The patients were between 21 and 89 years with mean age of 61.46 year. Renal cell carcinomas account 83.4% of the patients, benign renal tumours were 8.7% and transitional cell carcinomas were 7.7% of the patients in group 1. A total of 32.5% RCCs were classified as pT1a, 24.4% as pT1b, 15.1% as pT2a, 11.6% as pT2b, 15.1% as pT3a and 1.1% as pT4. There were 202 patients in group 2 and the patients were between 27 and 81 years with mean age of 58.5 year. Renal cell carcinomas comprised the main bulk of the tumours with 182 nephr...