Renal cell carcinoma natural history, complications, and prognosis
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
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]
- 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[7][8][9]:
- Low Komofsky performance score, a score to measure performance impairment in patients with cancer
- Elevated serum lactate dehydrogenase (LDH)
- Low hemoglobin level
- Elevated corrected serum calcium levels
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]
The following table summarizes the 5-year survival of patients according to cancer staging[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% |
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 7.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 12.0 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.
- ↑ 13.0 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.