Renal Cell Carcinoma (RCC) in Patients With End-Stage Renal Disease Exhibits Many Favourable Clinical, Pathologic, and Outcome Features Compared With RCC in the General Population

Abstract Background Patients with end-stage renal disease (ESRD) are at risk of developing renal tumours. Objective Compare clinical, pathologic, and outcome features of renal cell carcinomas (RCCs) in ESRD patients and in patients from the general population. Design, setting, and participants Twent...

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Published in:European urology 2011-08, Vol.60 (2), p.366-373
Main Authors: Neuzillet, Yann, Tillou, Xavier, Mathieu, Romain, Long, Jean-Alexandre, Gigante, Marc, Paparel, Philippe, Poissonnier, Laura, Baumert, Hervé, Escudier, Bernard, Lang, Hervé, Rioux-Leclercq, Nathalie, Bigot, Pierre, Bernhard, Jean-Christophe, Albiges, Laurence, Bastien, Laurence, Petit, Jacques, Saint, Fabien, Bruyere, Franck, Boutin, Jean-Michel, Brichart, Nicolas, Karam, Georges, Branchereau, Julien, Ferriere, Jean-Marie, Wallerand, Hervé, Barbet, Sébastien, Elkentaoui, Hicham, Hubert, Jacques, Feuillu, Benoit, Theveniaud, Pierre-Etienne, Villers, Arnauld, Zini, Laurent, Descazeaux, Aurélien, Roupret, Morgan, Barrou, Benoit, Fehri, Karim, Lebret, Thierry, Tostain, Jacques, Terrier, Jean-Etienne, Terrier, Nicolas, Martin, Lucille, Dugardin, Fabrice, Galliot, Ismaël, Staerman, Frédéric, Azemar, Marie-Dominique, Irani, Jacques, Tisserand, Baptiste, Timsit, Marc-Olivier, Sallusto, Federico, Rischmann, Pascal, Guy, Laurent, Valeri, Antoine, Deruelle, Charles, Azzouzi, Abdel-Rahmène, Chautard, Denis, Mejean, Arnaud, Salomon, Laurent, Rigaud, Jérôme, Pfister, Christian, Soulié, Michel, Kleinclauss, François, Badet, Lionel, Patard, Jean-Jacques
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Cancer
Carcinoma, Renal Cell
Carcinoma, Renal Cell - etiology
Carcinoma, Renal Cell - mortality
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - therapy
Chi-Square Distribution
End-stage renal disease
Female
France
Human health and pathology
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - therapy
Kidney Neoplasms
Kidney Neoplasms - etiology
Kidney Neoplasms - mortality
Kidney Neoplasms - pathology
Kidney Neoplasms - therapy
Kidneys
Life Sciences
Male
Medical sciences
Middle Aged
Neoplasm Staging
Nephrology. Urinary tract diseases
Nephropathies. Renovascular diseases. Renal failure
Pathology
Prognosis
Proportional Hazards Models
Renal cell carcinoma
Renal failure
Retrospective Studies
Risk Assessment
Risk Factors
Survival Rate
Time Factors
Transplantation
Treatment Outcome
Tumors of the urinary system
Urology
Urology and Nephrology
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Summary:Abstract Background Patients with end-stage renal disease (ESRD) are at risk of developing renal tumours. Objective Compare clinical, pathologic, and outcome features of renal cell carcinomas (RCCs) in ESRD patients and in patients from the general population. Design, setting, and participants Twenty-four French university departments of urology participated in this retrospective study. Intervention All patients were treated according to current European Association of Urology guidelines. Measurements Age, sex, symptoms, tumour staging and grading, histologic subtype, and outcome were recorded in a unique database. Categoric and continuous variables were compared by using chi-square and student statistical analyses. Cancer-specific survival (CSS) was assessed by Kaplan-Meier and Cox methods. Results and limitations The study included 1250 RCC patients: 303 with ESRD and 947 from the general population. In the ESRD patients, age at diagnosis was younger (55 ± 12 yr vs 62 ± 12 yr); mean tumour size was smaller (3.7 ± 2.6 cm vs 7.3 ± 3.8 cm); asymptomatic (87% vs 44%), low-grade (68% vs 42%), and papillary tumours were more frequent (37% vs 7%); and poor performance status (PS; 24% vs 37%) and advanced T categories (≥3) were more rare (10% vs 42%). Consistently, nodal invasion (3% vs 12%) and distant metastases (2% vs 15%) occurred less frequently in ESRD patients. After a median follow-up of 33 mo (range: 1–299 mo), 13 ESRD patients (4.3%), and 261 general population patients (27.6%) had died from cancer. In univariate analysis, histologic subtype, symptoms at diagnosis, poor PS, advanced TNM stage, high Fuhrman grade, large tumour size, and non-ESRD diagnosis context were adverse predictors for survival. However, only PS, TNM stage, and Fuhrman grade remained independent CSS predictors in multivariate analysis. The limitation of this study is related to the retrospective design. Conclusions RCC arising in native kidneys of ESRD patients seems to exhibit many favourable clinical, pathologic, and outcome features compared with those diagnosed in patients from the general population.
ISSN:0302-2838
1873-7560
1421-993X
DOI:10.1016/j.eururo.2011.02.035