Renal cell carcinoma natural history, complications, and prognosis: Difference between revisions

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{{CMG}}
{{CMG}}; {{AE}} [[User:YazanDaaboul|Yazan Daaboul]]; [[User:Sergekorjian|Serge Korjian]]; {{Rim}}; {{F.K}}
{{Renal cell carcinoma}}
{{Renal cell carcinoma}}


==Overview==
==Overview==
Common complications of renal cell carcinoma include [[hypertension]], [[hypercalcemia]], [[Budd-Chiari syndrome|budd-chiari syndrome]], [[hepatic vein thrombosis]], [[polycythemia]], [[renal failure]], [[metastasis]]. Prognosis is generally poor, and the 5-year mortality of renal cell carcinoma is approximately 73.2%.


==Natural History==
==Natural History==
Frank and colleagues showed that tumor size correlates significantly with the odds of malignancy in renal cell carcinomas.<ref name="pmid14634382">{{cite journal| author=Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H| title=Solid renal tumors: an analysis of pathological features related to tumor size. | journal=J Urol | year= 2003 | volume= 170 | issue= 6 Pt 1 | pages= 2217-20 | pmid=14634382 | doi=10.1097/01.ju.0000095475.12515.5e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14634382  }} </ref>Similarly, clear cell and higher grade tumors are also considered to carry higher malignant potential.<ref name="pmid14634382">{{cite journal| author=Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H| title=Solid renal tumors: an analysis of pathological features related to tumor size. | journal=J Urol | year= 2003 | volume= 170 | issue= 6 Pt 1 | pages= 2217-20 | pmid=14634382 | doi=10.1097/01.ju.0000095475.12515.5e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14634382  }} </ref> High grade tumors are more likely to be malignant when their size is 7 cm or greater, compared to those smaller than 1 cm.<ref name="pmid14634382">{{cite journal| author=Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H| title=Solid renal tumors: an analysis of pathological features related to tumor size. | journal=J Urol | year= 2003 | volume= 170 | issue= 6 Pt 1 | pages= 2217-20 | pmid=14634382 | doi=10.1097/01.ju.0000095475.12515.5e | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14634382  }} </ref>
*The symptoms of renal cell carcinoma usually develop in the fifth decade of life, and start with symptoms such as hematuria, flank pain and palpable abdominal mass.<ref name="pmid26058870">{{cite journal |vauthors=Zhang L, Yao L, Li X, Jewett MA, He Z, Zhou L |title=Natural history of renal cell carcinoma: An immunohistochemical analysis of growth rate in patients with delayed treatment |journal=J. Formos. Med. Assoc. |volume=115 |issue=6 |pages=463–9 |date=June 2016 |pmid=26058870 |doi=10.1016/j.jfma.2015.05.003 |url=}}</ref>
*If left untreated, 1.3% of patients with renal cell carcinoma may progress to develop metastatic disease.<ref name="pmid19402168">{{cite journal |vauthors=Crispen PL, Viterbo R, Boorjian SA, Greenberg RE, Chen DY, Uzzo RG |title=Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance |journal=Cancer |volume=115 |issue=13 |pages=2844–52 |date=July 2009 |pmid=19402168 |pmc=2860784 |doi=10.1002/cncr.24338 |url=}}</ref>


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.<ref name="pmid16890647">{{cite journal| author=Remzi M, Ozsoy M, Klingler HC, Susani M, Waldert M, Seitz C et al.| title=Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. | journal=J Urol | year= 2006 | volume= 176 | issue= 3 | pages= 896-9 | pmid=16890647 | doi=10.1016/j.juro.2006.04.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16890647 }} </ref> Small tumors measuring less than 3 cm in diameter are considered less potentially aggressive than those larger than 3 cm.<ref name="pmid16890647">{{cite journal| author=Remzi M, Ozsoy M, Klingler HC, Susani M, Waldert M, Seitz C et al.| title=Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. | journal=J Urol | year= 2006 | volume= 176 | issue= 3 | pages= 896-9 | pmid=16890647 | doi=10.1016/j.juro.2006.04.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16890647 }} </ref> 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.<ref name="pmid16890647">{{cite journal| author=Remzi M, Ozsoy M, Klingler HC, Susani M, Waldert M, Seitz C et al.| title=Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. | journal=J Urol | year= 2006 | volume= 176 | issue= 3 | pages= 896-9 | pmid=16890647 | doi=10.1016/j.juro.2006.04.047 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16890647 }} </ref>
==Complications==
The following table summarizes the 5-year survival of patients according to cancer staging<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 | doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }} </ref><ref name="pmid10492179">{{cite journal| author=Javidan J, Stricker HJ, Tamboli P, Amin MB, Peabody JO, Deshpande A et al.| title=Prognostic significance of the 1997 TNM classification of renal cell carcinoma. | journal=J Urol | year= 1999 | volume= 162 | issue= 4 | pages= 1277-81 | pmid=10492179 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10492179 }} </ref>:
The following are possible complications of the primary tumor and its spread, associated paraneoplastic syndromes, or metastasis:<ref name="pmid3046641">{{cite journal |vauthors=Nielsen OJ, Jespersen FF, Hilden M |title=Erythropoietin-induced secondary polycythemia in a patient with a renal cell carcinoma. A case report |journal=APMIS |volume=96 |issue=8 |pages=688–94 |date=August 1988 |pmid=3046641 |doi= |url=}}</ref><ref name="pmid19212212">{{cite journal |vauthors=Shih KL, Yen HH, Su WW, Soon MS, Hsia CH, Lin YM |title=Fulminant Budd-Chiari syndrome caused by renal cell carcinoma with hepatic vein invasion: report of a case |journal=Eur J Gastroenterol Hepatol |volume=21 |issue=2 |pages=222–4 |date=February 2009 |pmid=19212212 |doi=10.1097/MEG.0b013e328305ba06 |url=}}</ref><ref name="pmid16985675">{{cite journal |vauthors=Palapattu GS, Kristo B, Rajfer J |title=Paraneoplastic syndromes in urologic malignancy: the many faces of renal cell carcinoma |journal=Rev Urol |volume=4 |issue=4 |pages=163–70 |date=2002 |pmid=16985675 |pmc=1475999 |doi= |url=}}</ref><ref name="pmid17443359">{{cite journal |vauthors=Pepper K, Jaowattana U, Starsiak MD, Halkar R, Hornaman K, Wang W, Dayamani P, Tangpricha V |title=Renal cell carcinoma presenting with paraneoplastic hypercalcemic coma: a case report and review of the literature |journal=J Gen Intern Med |volume=22 |issue=7 |pages=1042–6 |date=July 2007 |pmid=17443359 |pmc=2219737 |doi=10.1007/s11606-007-0189-1 |url=}}</ref>
*[[Hypertension]]
*[[Hypercalcemia]]
*[[Budd-Chiari syndrome]]
*[[Hepatic vein thrombosis]]
*[[Polycythemia]]
*Acute and chronic [[renal failure]]
*[[Metastasis]], commonly to bones, lungs, or brain
 
==Prognosis==
The presence of the following factors may correlate with a poorer prognosis in renal cell carcinoma:<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 | doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096 }} </ref><ref name="pmid10561319">{{cite journal| author=Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J| title=Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. | journal=J Clin Oncol | year= 1999 | volume= 17 | issue= 8 | pages= 2530-40 | pmid=10561319 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10561319 }} </ref><ref name="pmid14752067">{{cite journal| author=Motzer RJ, Bacik J, Schwartz LH, Reuter V, Russo P, Marion S et al.| title=Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma. | journal=J Clin Oncol | year= 2004 | volume= 22 | issue= 3 | pages= 454-63 | pmid=14752067 | doi=10.1200/JCO.2004.06.132 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14752067 }} </ref>
*Low Komofsky performance score, a score to measure performance impairment in patients with cancer
*Elevated serum [[lactate dehydrogenase]] (LDH)
*Low [[hemoglobin]] level
*[[Hypercalcemia|Elevated corrected serum calcium levels]]
 
Other prognostic scoring include the tumor-mode-metastasis (TNM) staging system and the Fuhrman nuclear grade.<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 | doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }} </ref><ref name="pmid11250993">{{cite journal| author=Zisman A, Pantuck AJ, Dorey F, Said JW, Shvarts O, Quintana D et al.| title=Improved prognostication of renal cell carcinoma using an integrated staging system. | journal=J Clin Oncol | year= 2001 | volume= 19 | issue= 6 | pages= 1649-57 | pmid=11250993 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11250993  }} </ref><ref name="pmid15310775">{{cite journal| author=Patard JJ, Kim HL, Lam JS, Dorey FJ, Pantuck AJ, Zisman A et al.| title=Use of the University of California Los Angeles integrated staging system to predict survival in renal cell carcinoma: an international multicenter study. | journal=J Clin Oncol | year= 2004 | volume= 22 | issue= 16 | pages= 3316-22 | pmid=15310775 | doi=10.1200/JCO.2004.09.104 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15310775  }} </ref>
 
===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.<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 | doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096 }} </ref>
 
* Between 2004 and 2010, the 5-year relative survival of patients with kidney cancer was 73.7%.<ref name="SEER">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.</ref>


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.<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 | doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }} </ref>
* 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.<ref name="SEER">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.</ref>


==Complications==
* 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:<ref name="SEER">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.</ref>
Patients with renal cell carcinoma are at risk of [[hepatic vein thrombosis]] or [[Budd-Chiari syndrome]]


==Prognosis==
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
The outcome varies depending on the size of the tumor, whether it is confined to the kidney or not, and the presence or absence of metastatic spread. The Furhman grading, which measures the aggressiveness of the tumor, may also be associated with survival, although the data is not as strong to support this.
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Stage'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | '''5-year relative survival (%), (2004-2010)'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''All stages'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |72.4%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Localized'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |91.8%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Regional'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |64.7%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Distant'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |12.1%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unstaged'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |32.2%
|}


The [[five year survival rate]] is around 90-95% for tumors less than 4 cm. For larger tumors confined to the kidney without venous invasion, survival is still relatively good at 80-85%. For tumors that extend through the renal capsule and out of the local fascial investments, the survivability reduces to near 60%. If it has metastasized to the lymph nodes, the 5-year survival is around 5 % to 15 %. If it has spread metastatically to other organs, the 5-year survival rate is less than 5 %.  
* 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.<ref name="SEER">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.</ref>


For those that have tumor recurrence after surgery, the prognosis is generally poor.  Renal cell carcinoma does not generally respond to [[chemotherapy]] or [[radiation]]. [[Immunotherapy]], which attempts to induce the body to attack the remaining cancer cells, has shown promise.  Recent trials are testing newer agents, though the current complete remission rate with these approaches are still low, around 12-20% in most series.
[[Image:5-year survival of kidney cancer in USA.PNG|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]]


Every year, about 12,000 people in the US die from renal cell carcinoma.
The following table summarizes the 5-year survival of patients according to cancer staging<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 | doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }} </ref><ref name="pmid10492179">{{cite journal| author=Javidan J, Stricker HJ, Tamboli P, Amin MB, Peabody JO, Deshpande A et al.| title=Prognostic significance of the 1997 TNM classification of renal cell carcinoma. | journal=J Urol | year= 1999 | volume= 162 | issue= 4 | pages= 1277-81 | pmid=10492179 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10492179  }} </ref>:
{| style="border-collapse:collapse; text-align:left;" cellpadding="5" border="1" align="center"
|+ '''''Five-Year Survival of Various Stages of Renal Cell Carcinoma<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 | doi=10.1056/NEJMra043172 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }} </ref><ref name="pmid10492179">{{cite journal| author=Javidan J, Stricker HJ, Tamboli P, Amin MB, Peabody JO, Deshpande A et al.| title=Prognostic significance of the 1997 TNM classification of renal cell carcinoma. | journal=J Urol | year= 1999 | volume= 162 | issue= 4 | pages= 1277-81 | pmid=10492179 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10492179  }} </ref>'''''
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Stage''' || style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Tumor Characteristics'''|| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Five-Year Survival'''
|-
| bgcolor="#DCDCDC" |'''Stage I''' || Tumor < 7 cm in greatest dimension, limited to kidney || 95%
|-
| bgcolor="#DCDCDC" |'''Stage II''' || Tumor > 7 cm in greatest dimension, limited to kidney || 88%
|-
| bgcolor="#DCDCDC" |'''Stage III''' || Tumor in major veins or adrenal glands, tumor within Gerota's fascia, or 1 regional lymph node involved || 59%
|-
| bgcolor="#DCDCDC" |'''Stage IV''' || Tumor beyond Gerota's fascia or > 1 regional lymph node involved || 20%
|}
<sup><center>Adapted from Cohen HT, McGovern FJ. Renal-cell carcinoma. ''N Engl J Med''. 2005; 353:2477-90.</center></sup>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs content]]
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[[Category:Kidney diseases]]
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[[Category:Nephrology]]
[[Category:Nephrology]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]

Latest revision as of 15:39, 10 December 2018


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]; Farima Kahe M.D. [3]

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Overview

Common complications of renal cell carcinoma include hypertension, hypercalcemia, budd-chiari syndrome, hepatic vein thrombosis, polycythemia, renal failure, metastasis. Prognosis is generally poor, and the 5-year mortality of renal cell carcinoma is approximately 73.2%.

Natural History

  • The symptoms of renal cell carcinoma usually develop in the fifth decade of life, and start with symptoms such as hematuria, flank pain and palpable abdominal mass.[1]
  • If left untreated, 1.3% of patients with renal cell carcinoma may progress to develop metastatic disease.[2]

Complications

The following are possible complications of the primary tumor and its spread, associated paraneoplastic syndromes, or metastasis:[3][4][5][6]

Prognosis

The presence of the following factors may correlate with a poorer prognosis in renal cell carcinoma:[7][8][9]

Other prognostic scoring include the tumor-mode-metastasis (TNM) staging system and the Fuhrman nuclear grade.[7][10][11]

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.[7]
  • Between 2004 and 2010, the 5-year relative survival of patients with kidney cancer was 73.7%.[12]
  • 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.[12]
  • 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:[12]
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.[12]

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[7][13]:

Five-Year Survival of Various Stages of Renal Cell Carcinoma[7][13]
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. ↑ Zhang L, Yao L, Li X, Jewett MA, He Z, Zhou L (June 2016). "Natural history of renal cell carcinoma: An immunohistochemical analysis of growth rate in patients with delayed treatment". J. Formos. Med. Assoc. 115 (6): 463–9. doi:10.1016/j.jfma.2015.05.003. PMID 26058870.
  2. ↑ Crispen PL, Viterbo R, Boorjian SA, Greenberg RE, Chen DY, Uzzo RG (July 2009). "Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance". Cancer. 115 (13): 2844–52. doi:10.1002/cncr.24338. PMC 2860784. PMID 19402168.
  3. ↑ Nielsen OJ, Jespersen FF, Hilden M (August 1988). "Erythropoietin-induced secondary polycythemia in a patient with a renal cell carcinoma. A case report". APMIS. 96 (8): 688–94. PMID 3046641.
  4. ↑ Shih KL, Yen HH, Su WW, Soon MS, Hsia CH, Lin YM (February 2009). "Fulminant Budd-Chiari syndrome caused by renal cell carcinoma with hepatic vein invasion: report of a case". Eur J Gastroenterol Hepatol. 21 (2): 222–4. doi:10.1097/MEG.0b013e328305ba06. PMID 19212212.
  5. ↑ Palapattu GS, Kristo B, Rajfer J (2002). "Paraneoplastic syndromes in urologic malignancy: the many faces of renal cell carcinoma". Rev Urol. 4 (4): 163–70. PMC 1475999. PMID 16985675.
  6. ↑ Pepper K, Jaowattana U, Starsiak MD, Halkar R, Hornaman K, Wang W, Dayamani P, Tangpricha V (July 2007). "Renal cell carcinoma presenting with paraneoplastic hypercalcemic coma: a case report and review of the literature". J Gen Intern Med. 22 (7): 1042–6. doi:10.1007/s11606-007-0189-1. PMC 2219737. PMID 17443359.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 Cohen HT, McGovern FJ (2005). "Renal-cell carcinoma". N Engl J Med. 353 (23): 2477–90. doi:10.1056/NEJMra043172. PMID 16339096.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 12.0 12.1 12.2 12.3 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.
  13. ↑ 13.0 13.1 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.
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