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==Overview==
==Overview==
The projected 5-year survival is significantly associated with the stage of the tumor at diagnosis. Stage I tumors are associated with more than 90% 5-year survival vs. less than 20% survival for tumors of stage IV. The potential aggression of a tumor has been shown to be associated with tumor size, grade of tumor, and histopathological subtype. High grade tumors greater than 7 cm of clear cell type generally have a higher aggressive potential than low grade tumors smaller than 3 cm of papillary type. Finally, complications vary according to the local extension of the tumor, and the presence of paraneoplastic syndromes and/or metastases.
The projected 5-year survival is associated with the stage of the renal cell carcinoma. Stage I tumors are associated with more than 90% 5-year survival vs. less than 20% survival for tumors of stage IV. The potential aggression of a tumor has been shown to be associated with tumor size, grade of tumor, and histopathological subtype. High grade tumors greater than 7 cm of clear cell type generally have a higher aggressive potential than low grade tumors smaller than 3 cm of papillary type. Finally, complications vary according to the local extension of the tumor, and the presence of paraneoplastic syndromes and/or metastases.


==Natural History==
==Natural History==

Revision as of 18:19, 24 August 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul; Serge Korjian; Rim Halaby, M.D. [2]

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Overview

The projected 5-year survival is associated with the stage of the renal cell carcinoma. Stage I tumors are associated with more than 90% 5-year survival vs. less than 20% survival for tumors of stage IV. The potential aggression of a tumor has been shown to be associated with tumor size, grade of tumor, and histopathological subtype. High grade tumors greater than 7 cm of clear cell type generally have a higher aggressive potential than low grade tumors smaller than 3 cm of papillary type. Finally, complications vary according to the local extension of the tumor, and the presence of paraneoplastic syndromes and/or metastases.

Natural History

Frank and colleagues showed that tumor size correlates significantly with the odds of malignancy in renal cell carcinomas.[1]Similarly, clear cell and higher grade tumors are also considered to carry higher malignant potential.[1] High grade tumors are more likely to be malignant when their size is 7 cm or greater, compared to those smaller than 1 cm.[1]

According to meta-analysis results from Remzi and colleagues in 2006, size is an important factor in small cell renal carcinoma to assess aggression of disease.[2] Small tumors measuring less than 3 cm in diameter are considered less potentially aggressive than those larger than 3 cm.[2] As such, a diameter of 3 cm is considered a threshold for potential of aggression in renal cell carcinoma and might predict the natural history of the disease.[2]

Complications

The following are possible complications of the primary tumor and its spread, associated paraneoplastic syndromes, or metastasis:

Prognosis

The presence of the following factors may correlate with a poorer prognosis in renal cell carcinoma[3][4][5]:

Other prognostic scoring include the tumor-mode-metastasis (TNM) staging system and the Fuhrman nuclear grade.[3][6][7]

Survival

  • Patients with metastatic renal cell carcinoma have a median age of survival reaching approximately 13 months. Available medical therapy, however, may significantly prolong survival of patients with metastatic disease.[3]
  • Between 2004 and 2010, the 5-year relative survival of patients with kidney cancer was 73.7%.[8]
  • When stratified by age, the 5-year relative survival of patients with kidney cancer was 78% and 65% for patients <65 and ≥ 65 years of age respectively.[8]
  • The survival of patients with kidney cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of kidney cancer:[8]
Stage 5-year relative survival (%), (2004-2010)
All stages 72.4%
Localized 91.8%
Regional 64.7%
Distant 12.1%
Unstaged 32.2%
  • Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of kidney cancer by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[8]

5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of kidney cancer by stage at diagnosis according to SEER

The following table summarizes the 5-year survival of patients according to cancer staging[3][9]:

Five-Year Survival of Various Stages of Renal Cell Carcinoma[3][9]
Stage Tumor Characteristics Five-Year Survival
Stage I Tumor < 7 cm in greatest dimension, limited to kidney 95%
Stage II Tumor > 7 cm in greatest dimension, limited to kidney 88%
Stage III Tumor in major veins or adrenal glands, tumor within Gerota's fascia, or 1 regional lymph node involved 59%
Stage IV Tumor beyond Gerota's fascia or > 1 regional lymph node involved 20%
Adapted from Cohen HT, McGovern FJ. Renal-cell carcinoma. N Engl J Med. 2005; 353:2477-90.

References

  1. 1.0 1.1 1.2 Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H (2003). "Solid renal tumors: an analysis of pathological features related to tumor size". J Urol. 170 (6 Pt 1): 2217–20. doi:10.1097/01.ju.0000095475.12515.5e. PMID 14634382.
  2. 2.0 2.1 2.2 Remzi M, Ozsoy M, Klingler HC, Susani M, Waldert M, Seitz C; et al. (2006). "Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter". J Urol. 176 (3): 896–9. doi:10.1016/j.juro.2006.04.047. PMID 16890647.
  3. 3.0 3.1 3.2 3.3 3.4 Cohen HT, McGovern FJ (2005). "Renal-cell carcinoma". N Engl J Med. 353 (23): 2477–90. doi:10.1056/NEJMra043172. PMID 16339096.
  4. Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J (1999). "Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma". J Clin Oncol. 17 (8): 2530–40. PMID 10561319.
  5. Motzer RJ, Bacik J, Schwartz LH, Reuter V, Russo P, Marion S; et al. (2004). "Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma". J Clin Oncol. 22 (3): 454–63. doi:10.1200/JCO.2004.06.132. PMID 14752067.
  6. Zisman A, Pantuck AJ, Dorey F, Said JW, Shvarts O, Quintana D; et al. (2001). "Improved prognostication of renal cell carcinoma using an integrated staging system". J Clin Oncol. 19 (6): 1649–57. PMID 11250993.
  7. Patard JJ, Kim HL, Lam JS, Dorey FJ, Pantuck AJ, Zisman A; et al. (2004). "Use of the University of California Los Angeles integrated staging system to predict survival in renal cell carcinoma: an international multicenter study". J Clin Oncol. 22 (16): 3316–22. doi:10.1200/JCO.2004.09.104. PMID 15310775.
  8. 8.0 8.1 8.2 8.3 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.
  9. 9.0 9.1 Javidan J, Stricker HJ, Tamboli P, Amin MB, Peabody JO, Deshpande A; et al. (1999). "Prognostic significance of the 1997 TNM classification of renal cell carcinoma". J Urol. 162 (4): 1277–81. PMID 10492179.