Renal cell carcinoma natural history, complications, and prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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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.
Natural History & Prognosis
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
The following are possible complications of the primary tumor and its spread, associated paraneoplastic syndromes, or metastasis:
- Hypertension
- Hypercalcemia
- Budd-Chiari syndrome
- Hepatic vein thrombosis
- Polycythemia
- Acute and chronic renal failure
- Metastasis, commonly to bones, lungs, or brain
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.