Journal of Clinical & Experimental OncologyISSN: 2324-9110

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Commentary, J Clin Exp Oncol Vol: 4 Issue: 1

Correlation between the Presentation of Renal Cell Carcinoma and its Prognosis

Doaa Attia* and Ahmed Fouad Kotb
Department of Urology, Faculty of Medicine, Alexandria University, Egypt
Corresponding author : Ahmed Fouad Kotb, M.D, PhD
MRCS, FEBU, Department of Urology, Faculty of Medicine, Alexandria University, Egypt
E-mail: [email protected]
Received: March 03, 2015 Accepted: May 14, 2015 Published: May 21, 2015
Citation: Kotb AF, Attia D (2015) Correlation between the Presentation of Renal Cell Carcinoma and its Prognosis. J Clin Exp Oncol 4:1. doi:10.4172/2324-9110.1000136

Abstract

Introduction: The increased use of modern imaging modalities has led to a significant increase in the discovery of incidental renal tumours.Many reports have reported local symptoms due to renal cell carcinoma to be of prognostic impact. The aim of our review is to discuss important publications correlating patients’ presentations with the clinical and survival outcomes.

Methods: Medline review by two independent researchers, using keywords (incidental, flank pain, mass, hematuria) in combination with renal cell carcinoma was accomplished. Results: Few publications including an accepted number of papers was agreed upon to be included in our review.

Conclusion: Patients with renal cell carcinoma presenting with symptoms in the form of pain, mass or hematuria have worse clinical and pathological outcomes than patients diagnosed incidentally.

Keywords: Renal cell carcinoma hematuria; Incidental; Flank pain; Renal mass

Keywords

Renal cell carcinoma hematuria; Incidental; Flank pain; Renal mass

Introduction

The increased use of modern imaging modalities has led to a significant increase in the discovery of incidental renal tumours. Skinner et al. [1] reported that 7% of tumours were diagnosed incidentally from 1935 to 1965. Konnak et al. [2] reported the incidental cases to constitute 13% of cases diagnosed from 1961 to 1973, while 48% of cases diagnosed incidentally from 1980 to 1984. Beisland et al. [3] reviewed 368 patients between 1978 and 2000 and reported the incidence of incidentally diagnosed renal tumours to be 21.1% and 34.7% in the time period between 1978- 1987 and 1988- 2000 respectively. More recently, Schlomer et al. [4] found that 74% of cases were incidentally diagnosed between 2000- 2005.
Hellsten et al. [5] demonstrated that two third of cases of renal cell carcinoma (RCC); studied at autopsy and were not diagnosed clinically, in the time period 1958- 1969.Kawaciuk et al. [6] reported the mode of presentation of renal tumours to be a significant factor, beside tumour size, stage and grade in determining the prognosis of the disease. Lee et al. [7] reported that the increase in incidental detection of renal tumours, has led to a stage migration of RCC toward lower stage. The objective of our study is to correlate the patient presentation; whether incidental or symptomatic with the clinical and pathological outcome of the disease.

Methods

Medline review by two independent researchers, using keywords (incidental, flank pain, mass, hematuria) in combination with renal cell carcinoma was accomplished. This was followed by group meeting to choose relative papers of high impact to get considered for our review. Difference in outcomes was primarily done between the group incidentally diagnosed with renal mass and those presenting with local symptoms.

Results

Few publications could be found discussing our subject of study and including a sufficient number of patients that was agreed upon to be more than 100 patients. Demonstration of outcome was reported in relation to the pathological outcome and/or survival data.

Discussion

Rabjerg et al. [8], constructed Danish single epidemiological study for 204 patients in 2011-2012, to detect the associated pathology and survival rate difference among patients discovered accidently and symptomatic.They found that the patients with incidental discovery have favorable prognosis, lower stage predominantly stage I and their mass size was smaller.
Palsdotitr et al. [9], conducted a retrospective cohort study in Iceland of 910 patients from 1971-2005 to compare the patients diagnosed with RCC due to incidental discovery and those who developed symptoms of hematuria, flank mass and pain and correlated it to the tumour stage and the survival rate. They discovered that patients who have been diagnosed accidently had better prognosis, lower stage and higher survival rates than the symptomatic patients. they found that the patients who are presented with flank pain (53% of the sample) and macroscopic hematuria (43.3%) had worse TNM stage (IV) and worse prognosis while the patients who have been incidentally discovered by U/S or CT (27.9%) had lower TNM stage (I) and better survival rates.
Dall’Oglio et al. [10] conducted a retrospective study (Jan 1988- july 1999) for 128 patients to demonstrate the difference in survival rates in RCC who presented with classical symptoms of hematuria, flank pain and mass and others who were discovered incidentally. They found that out of 128 patients, 51% were incidentally discovered and 24% of them have been managed conservatively with 5 year survival rate about 83-95% of the symptomatic group, only 9% of them were treated conservatively and had lower 5 year survival rate around 30-38. The study also showed that death rate from tumor progression was higher in symptomatic patients more than the ones who were discovered incidentally.
Volpe et al. [11], performed a retrospective study (March 1990- july 2002) for patients with renal mass <4 cm which are incidentally discovered and reported that most of incidentally discovered renal masses are small, asymptomatic, treated conservatively, and most of them are clear cell type, grade II and few were oncocytomas. Most of those small masses are treated conservatively with favorable prognosis and survival rate.
Petard et al. [12] reported that it is possible to classify symptoms for prognostic purposes. Patard et al. [13] also reported that a system combining tumour size and symptoms can accurately stratify patients with localized tumours for predicting survival, and symptoms classification is the strongest independent factor for distant metastases. Lee et al. [14] reported that 74% of organ confined tumours are found in asymptomatic cases, while 48% are found in symptomatic cases. The 5 year survival of incidental renal tumours in literatures ranges from 85- 91%. [15-17] the 5 years survival reported for symptomatic cases is about 65% [17].
Table 1 summarizes data from mentioned studies. We could not find in literatures a meta-analysis concerning the association of patients’ symptoms and the outcome of renal cell carcinoma. All available publications represent a sort of comparative studies between patients diagnosed incidentally and those diagnosed with symptoms due to the disease; this may represent a grade ӀӀӀ evidence for the association between the mode of presentations of patients with renal cell carcinoma and the outcomes of the disease.
Table 1: Key findings of studied publications.

Conclusion

Patients with renal cell carcinoma presenting with symptoms in the form of pain, mass or hematuria have worse clinical and pathological outcomes than patients diagnosed incidentally.

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