DOI QR코드

DOI QR Code

Clinical Prognostic Factors and Survival Outcome in Renal Cell Carcinoma Patients - A Malaysian Single Centre Perspective

  • Published : 2013.12.31

Abstract

Background: This study concerns clinical characteristics and survival of renal cell carcinoma (RCC) patients in University Malaya Medical Centre (UMMC), as well as the prognostic significance of presenting symptoms. Materials and Methods: The clinical characteristics, presenting symptoms and survival of RCC patients (n=151) treated at UMMC from 2003-2012 were analysed. Symptoms evaluated were macrohaematuria, flank pain, palpable abdominal mass, fever, lethargy, loss of weight, anaemia, elevated ALP, hypoalbuminemia and thrombocytosis. Univariate and multivariate Cox regression analyses were performed to determine the prognostic significance of these presenting symptoms. Kaplan Meier and log rank tests were employed for survival analysis. Results: The 2002 TNM staging was a prognostic factor (p<0.001) but Fuhrman grading was not significantly correlated with survival (p=0.088). At presentation, 76.8% of the patients were symptomatic. Generally, symptomatic tumours had a worse survival prognosis compared to asymptomatic cases (p=0.009; HR 4.74). All symptoms significantly affect disease specific survival except frank haematuria and loin pain on univariate Cox regression analysis. On multivariate analysis adjusted for stage, only clinically palpable abdominal mass remained statistically significant (p=0.027). The mean tumour size of palpable abdominal masses, $9.5{\pm}4.3cm$, was larger than non palpable masses, $5.3{\pm}2.7cm$ (p<0.001). Conclusions: This is the first report which includes survival information of RCC patients from Malaysia. Here the TNM stage and a palpable abdominal mass were independent predictors for survival. Further investigations using a multicentre cohort to analyse mortality and survival rates may aid in improving management of these patients.

References

  1. Bektas S, Bahadir B, Kandemir NO, et al (2009). Intraobserver and interobserver variability of Fuhrman and modified Fuhrman grading systems for conventional renal cell carcinoma. Kaohsiung J Med Sci, 25, 596-600. https://doi.org/10.1016/S1607-551X(09)70562-5
  2. Delahunt B (2009). Advances and controversies in grading and staging of renal cell carcinoma. Mod Pathol, 22, 24-36. https://doi.org/10.1038/modpathol.2008.183
  3. Farooqui M, Hassali MA, Knight A, et al (2013). A qualitative exploration of Malaysian cancer patients' perceptions of cancer screening. BMC Public Health, 13, 48. https://doi.org/10.1186/1471-2458-13-48
  4. Ferlay J, Shin HR, Bray R, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917. https://doi.org/10.1002/ijc.25516
  5. Ficarra V, Prayer-Galetti T, Novella G, et al (2003). Incidental detection beyond pathological factors as prognostic predictor of renal cell carcinoma. Eur Urol, 43, 663-9. https://doi.org/10.1016/S0302-2838(03)00142-8
  6. Frank I, Blute ML, Cheville JC, et al (2002). An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score. J Urol, 168, 2395-400. https://doi.org/10.1016/S0022-5347(05)64153-5
  7. Greene FL, Page DL, Fleming LP (2002). AJCC Cancer Staging Manual 6th Edition. New York: Springer.
  8. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA: A Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
  9. Kanesvaran R, Wong CF, Poon E, et al (2009). Comparison of the UISS and the SSIGN Scores for survival prediction in Asian patients with clear cell renal cell carcinoma. Genitourinary Cancers Symposium.
  10. Kim HL, Belldegrun AS, Freitas DG, et al (2003). Paraneoplastic signs and symptoms of renal cell carcinoma: implications for prognosis. J Urol, 170, 1742-6. https://doi.org/10.1097/01.ju.0000092764.81308.6a
  11. Kim HL, Han KR, Zisman A, et al (2004). Cachexia-like symptoms predict a worse prognosis in localized t1 renal cell carcinoma. J Urol, 171, 1810-3. https://doi.org/10.1097/01.ju.0000121440.82581.d3
  12. Kinouchi T, Saiki S, Meguro N, et al (1999). Impact of tumor size on the clinical outcomes of patients with Robson State I renal cell carcinoma. Cancer, 85, 689-95. https://doi.org/10.1002/(SICI)1097-0142(19990201)85:3<689::AID-CNCR19>3.0.CO;2-7
  13. Lee CT, Katz J, Fearn PA, et al (2002). Mode of presentation of renal cell carcinoma provides prognostic information. Urol Oncol, 7, 135-40. https://doi.org/10.1016/S1078-1439(01)00185-5
  14. Lee LS, Yuen JS, Sim HG (2011). Renal cell carcinoma in young patients is associated with poorer prognosis. Ann Acad Med Singapore, 40, 401-6.
  15. Ljungberg B, Campbell SC, Choi HY, et al (2011). The epidemiology of renal cell carcinoma. Eur Urol, 60, 615-21. https://doi.org/10.1016/j.eururo.2011.06.049
  16. Naito S, Tomita Y, Rha SY, et al (2010) Kidney cancer working group report. Jpn J Clin Oncol, 40, 51-6. https://doi.org/10.1093/jjco/hyq127
  17. NCR (2005). Cancer incidence in Peninsular Malaysia 2003-2005. Ministry of Health Malaysia.
  18. NCR (2006). Malaysian cnacer statistics - Data and figure Peninsular Malaysia 2006. Ministry of Health Malaysia.
  19. Palsdottir HB, Hardarson S, Petursdottir V, et al (2012). Incidental detection of renal cell carcinoma is an independent prognostic marker: results of a long-term, whole population study. J Urol, 187, 48-53. https://doi.org/10.1016/j.juro.2011.09.025
  20. Patard JJ, Leray E, Rodriguez A, et al (2003). Correlation between symptom graduation, tumor characteristics and survival in renal cell carcinoma. Eur Urol, 44, 226-32. https://doi.org/10.1016/S0302-2838(03)00216-1
  21. SCR (2011). Singapore Cancer Registry Interim Annual Registry Report, Trends in Cancer Incidence in Singapore 2007-2011. National Registry of Diseases Office.
  22. Schips L, Lipsky K, Zigeuner R, et al (2003). Impact of tumorassociated symptoms on the prognosis of patients with renal cell carcinoma: a single-center experience of 683 patients. Urol, 62, 1024-8. https://doi.org/10.1016/S0090-4295(03)00763-5

Cited by

  1. Influence of Curcumin on HOTAIR-Mediated Migration of Human Renal Cell Carcinoma Cells vol.15, pp.10, 2014, https://doi.org/10.7314/APJCP.2014.15.10.4239
  2. The Association of Platelet Count with Clinicopathological Significance and Prognosis in Renal Cell Carcinoma: A Systematic Review and Meta-Analysis vol.10, pp.5, 2015, https://doi.org/10.1371/journal.pone.0125538
  3. P53 and MDM2 Over-expression and Five-year Survival of Kidney Cancer Patients Undergoing Radical Nephrectomy - Iranian Experience vol.16, pp.12, 2015, https://doi.org/10.7314/APJCP.2015.16.12.5043
  4. The long noncoding RNA urothelial carcinoma-associated 1 overexpression as a poor prognostic biomarker in clear cell renal cell carcinoma vol.39, pp.5, 2017, https://doi.org/10.1177/1010428317698377
  5. Preditores de mortalidade em pacientes submetidos à nefrectomia por carcinoma de células renais não metastático em um centro de referência no Nordeste Brasileiro vol.44, pp.3, 2017, https://doi.org/10.1590/0100-69912017003006
  6. Value of intravoxel incoherent motion for differential diagnosis of renal tumors pp.1600-0455, 2018, https://doi.org/10.1177/0284185118778884
  7. Optimising assessment of kidney function when managing localised renal masses vol.207, pp.3, 2017, https://doi.org/10.5694/mja17.00161