Korean J Urol.  2014 Aug;55(8):505-510. 10.4111/kju.2014.55.8.505.

Associations Between Presenting Symptoms, Clinicopathological Parameters, and Prognosis in a Contemporary Series of Patients With Renal Cell Carcinoma

• Hofbauer S
• de Martino M
• Seemann C
• Zamani N
• Lucca I
• Haitel A
• Shariat SF
• Klatte T

• KMID: 1794583
• DOI: http://doi.org/10.4111/kju.2014.55.8.505

Abstract

PURPOSE
To evaluate the impact of presenting symptoms on survival in a contemporary series of patients with renal cell carcinoma (RCC).
MATERIALS AND METHODS
We prospectively recorded data on the presenting symptoms, pathology, and RCC-specific survival of 633 consecutive RCC patients who underwent surgery between 2003 and 2012.
RESULTS
Four hundred thirty-three RCCs (68%) were incidental, 111 (18%) were associated with local symptoms, and 89 (14%) were associated with systemic symptoms. Among those with incidental RCC, 317 patients (73%) were completely asymptomatic and 116 patients (27%) presented with symptoms not related to the tumor. During a median follow-up interval of 40 months (interquartile range: 39 to 69 months), 77 patients died from RCC. In univariate analyses, symptom classification was significantly associated with RCC-specific survival (p<0.001). Patients with incidental RCC and unrelated symptoms tended to have worse prognosis than did patients who were completely asymptomatic, although this difference was not statistically significant (p=0.057). The symptom classification was associated with advanced TNM stages (p<0.001) and grade (p<0.001).
CONCLUSIONS
This study confirms that presenting symptoms are associated with tumor characteristics and survival. The majority of RCCs are diagnosed incidentally in patients without any symptoms or with symptoms not related to RCC. Patients in the latter group tend to have a worse prognosis than do patients who are completely asymptomatic. With the increasing number of incidentally diagnosed RCCs, substratification of patients with incidental tumors may be prognostically relevant.

Keyword

Diagnosis; Prognosis; Renal cell carcinoma; Symptoms

MeSH Terms

Aged
Carcinoma, Renal Cell/*diagnosis/pathology/surgery
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Kidney Neoplasms/*diagnosis/pathology/surgery
Male
Middle Aged
Neoplasm Staging
Nephrectomy/methods
Prognosis
Prospective Studies

Figure

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  FIG. 1 Kaplan-Meier specific survival according to Patard's symptom classification for 633 renal cell carcinoma (RCC) patients: S1, asymptomatic or incidental tumor (S1a, totally asymptomatic; S1b, symptoms not related to renal tumor); S2, local symptoms; and S3, systemic symptoms. S1b patients tended to have worse survival than did S1a patients, but this difference was not statistically significant.

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