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
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% |
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
Prognosis
The presence of the following factors may correlate with a poorer prognosis in renal cell carcinoma[3][5][6]:
- 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.[3][7][8]
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%.[9]
- 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.[9]
- 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:[9]
| 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.[9]
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 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.
- ↑ 4.0 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.
- ↑ 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.
- ↑ 9.0 9.1 9.2 9.3 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.