Introduction and Objectives
Renal cell cancer (RCC) represents 2–3% of all malignant tumors in adults. Nuclear grading according to Fuhrman, pathological stage of primary tumors, lymph nodes metastases and presence of distant metastases at diagnosis are independent predictors of cancer-specific mortality in patients with RCC. Majority of renal tumours are diagnosed by ultrasound performed for different reasons. Despite increased detection rate survival has not improved. RCC characterized by high mortality, reaching about 40% of all surgically treated patients. To describe survival patients after nephrectomy due to low-differentiated RCC.
Material and Methods
A total of 40 patients with lowdifferentiated RCC (mean age 61.5 years), treated between January 2005 and November 2007, were included into the study. Mean observation period was 23.6 months (range from 14 to 36 months). In all cases histological confirmation of G3 or G4 RCC was received. G3 tumors were present in 31 patients (pT1b-3; pT2–9; pT3a-13; pT3b-5; pT4–1) and G4 in 9 patients (pT1b-1; pT2–3; pT3a-5). In all cases chest X-ray and abdominal CT were performed as a standard procedure. There were no metastases before surgery. After surgery all patients were followed strictly by urologist. Deaths information has been received from families and discharge cards.
14 patients (35%) out of 40 died during observation, including 6 (67%) out of 9 with G4 tumors (pT1b-1; pT2–2; pT3a-3) and 8 (25.8%) out of 31 with G3 tumors (pT2–1; pT3a-3; pT3b-3; pT4–1). In all cases RCC progression was the reason of death. 4 patients died in the first year after surgery, 8 patients in the second and next 2 in the third year. Metastases were found in 21 patients (52.5%) during postoperative observation. Most of them were present in lungs (12 cases, 30%) but in 7 cases (17.5%) coexisted with enlarged lymph nodes, in 2 cases (5%) with liver metastases, and in 1 case with local recurrence. Isolated bone metastases were observed in 4 cases (10%) and isolated liver metastases in 2 (5%). Among other 3 patients brain metastases, local lodge recurrence or disseminated malignant disease were found.
In spite of development in medicine and modifications in surgical technique, prognosis in low-differentiated RCC is invariable.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.