Renal cell carcinoma natural history, complications, and prognosis
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Overview
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] The following table summarizes the 5-year survival of patients according to cancer staging[3][4]:
| 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% |
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]
Complications
Patients with renal cell carcinoma are at risk of hepatic vein thrombosis or Budd-Chiari syndrome
Prognosis
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.
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 %.
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.
Every year, about 12,000 people in the US die from renal cell carcinoma.
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 3.0 3.1 3.2 Cohen HT, McGovern FJ (2005). "Renal-cell carcinoma". N Engl J Med. 353 (23): 2477–90. doi:10.1056/NEJMra043172. PMID 16339096.
- ↑ 4.0 4.1 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.