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  Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 4  |  Page : 572-574
 

Detailed study of survival of patients with renal cell carcinoma in India


Lakeshore Hospital, Kochi, Kerala, India

Date of Web Publication21-Apr-2017

Correspondence Address:
GP Abraham
Lakeshore Hospital, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.204758

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 » Abstract 

PURPOSE: Renal cell carcinoma (RCC) accounts for approximately 90% of all renal malignancies. The rates of kidney cancers are high in developed countries and low in eastern countries and Africa. The objective was to conduct a survival study among Indian population following nephrectomy for RCC as there was a paucity of Indian studies in medical literature. MATERIALS AND METHODS: We conducted a follow-up study of eighty RCC patients who had nephrectomy between January 2003 and December 2010. These patients had pathological diagnosis after nephrectomy. The follow-up was done up to December 2015. The survival statistics were compiled according to Kaplan–Meier survival curves. RESULTS: The overall survival of eighty patients was 77%. The patients with tumor size ≤7 cm and the patients with tumor size >7 cm showed significant statistical difference at 5-year survival (P < 0.0001). The patients with low nuclear grade (1 and 2) and the patients with high nuclear grade (3 and 4) showed significant statistical difference at 5-year survival (P < 0.0001). The patients with tumor node metastasis stage below T3 and the patients with clinical stage above or equal to T3 showed significant statistical difference at 5-year survival (P = 0.003). CONCLUSION: This study has demonstrated the importance of factors such as tumor size, nuclear grade, and stage in the assessment of prognosis of RCC patients. More studies in India with more patients are needed to demonstrate the importance of these prognostic factors.


Keywords: Nephrectomy, renal carcinoma, survival


How to cite this article:
Abraham G, Cherian T, Mahadevan P, Avinash T, George D, Manuel E. Detailed study of survival of patients with renal cell carcinoma in India. Indian J Cancer 2016;53:572-4

How to cite this URL:
Abraham G, Cherian T, Mahadevan P, Avinash T, George D, Manuel E. Detailed study of survival of patients with renal cell carcinoma in India. Indian J Cancer [serial online] 2016 [cited 2017 Sep 20];53:572-4. Available from: http://www.indianjcancer.com/text.asp?2016/53/4/572/204758



 » Introduction Top


Renal cell carcinoma (RCC) accounts for approximately 90% of all renal malignancies. Traditionally, 30–40% of patients with RCC have died due to the disease as compared to 20% mortality rates associated with prostate and urinary bladder cancers.[1] The rates of kidney cancers are high in Western developed countries and low in Eastern and developing countries.[2] Among the developed countries, the Czech Republic, the USA, and Canada have higher rates of renal cancer. Asians living in the USA also have a lower incidence rate of RCC.[3]

In India, the estimated incidence of RCC among males is about 2/100,000 population and among females is about 1/100,000 population. Only a few studies related to survival of RCC patients in India are available in the medical literature. We present a detailed study of 5-year survival rates of Indian patients with RCC.


 » Materials and Methods Top


During the period between January 2003 and December 2010, eighty patients of RCC were diagnosed after nephrectomy. In all cases, a detailed clinical history and a complete physical examination of the patients were carried out before the nephrectomy operations. They also underwent hematological and biochemical studies, abdominal ultrasound scans, and computed tomography scans. Multiple sections from the tumor including sections for the evaluation of perinephric fat invasion, renal sinus invasion, and renal vein invasion were taken and were reviewed by two pathologists (Mahadevan P and Cherian T). The nuclear grade was evaluated according to Fuhrman grading.[4] The staging of RCC was recorded according to the World Health Organization tumor node metastasis (TNM) classification. From the date of nephrectomy, patients were followed up at least for 60 months. Some patients were followed up at the urology clinic. The last follow-ups were done in December 2015.

Survival statistics

The survival statistics were compiled according to Kaplan–Meier survival curves. The software program developed by GraphPad Prism, San Diego, CA, USA was used to plot the Kaplan–Meier survival curves.[5] The statistical difference between two groups was confirmed if P< 0.01.


 » Results Top


Among the eighty RCC patients, 69 (86%) were male and 11 (14%) were female. The mean age at surgery was 54.9 years. The peak incidence was between 51 and 60 years of age. Sixty cases (75%) had tumor size ≤7 cm and twenty cases (25%) had tumor size >7 cm. Five (6%) RCC cases had nuclear Grade 1, 53 (66%) cases had nuclear Grade 2, 13 (16%) cases had nuclear Grade 3, and 9 (11%) cases had nuclear Grade 4. Among the eighty patients, 33 (41%) patients were in tumor stage T1, 7 (9%) patients were in tumor stage T2, 24 (30%) patients were in tumor stage T3a, 10 (13%) patients were in tumor stage T3b, and 6 (7%) patients were in tumor stage T4.

Survival of all patients

The patients were followed up for at least 5 years (60 months) from the date of surgery. Eleven patients were lost to follow-up. At the last follow-up, 17 patients had expired. The mean period from nephrectomy to death was 10.1 months (range 1–49 months). The overall survival of patients at 5 years is 77%.

Survival according to age

Forty-two patients were ≤55 years and 38 patients were >55 years of age. The 5-year survival for the first group was 86.6% and survival for the second group was 68.05%. No significant statistical difference was noted between the two groups at 5-year survival (P = 0.035).

Survival according to tumor size

The 5-year survival for patients with tumor size ≤7 cm was 87.82% and for patients with tumor size >7 cm was 47.5%. [Figure 1] shows Kaplan–Meier survival curves for both groups. The two groups showed significant statistical difference at 5-year survival (P < 0.0001).
Figure 1: Kaplan–Meier survival curves according to tumor size (≤7 cm and >7 cm)

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Survival according to nuclear grade

The 5-year survival for patients with tumor cells showing nuclear Grades 1 and 2 was 90.87% and for nuclear Grades 3 and 4 was 43.06%. [Figure 2] shows survival curves for patients with tumor cells showing nuclear Grades 1 and 2 and nuclear Grades 3 and 4. The two groups showed significant statistical difference at 5-year survival (P < 0.0001).
Figure 2: Kaplan–Meier survival curves according to nuclear grade of tumor cells (Grade 1–4)

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Survival according to tumor node metastasis stage

The 5-year survival for patients below stage T3 was 91.8% and for stage above or equal to T3 was 64.14%. [Figure 3] shows Kaplan–Meier survival curves for patients with TNM stage below T3 and TNM stage above or equal to T3. The two groups showed significant statistical difference at 5-year survival (P = 0.003).
Figure 3: Kaplan–Meier survival curves according to tumor node metastasis stage classification (

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 » Discussion Top


The survival of the patients after nephrectomy depends on prognostic factors such as age, stage, nuclear grade, histological subtype, tumor size, and performance status.[6] This study has also analyzed the influence of age, tumor size, nuclear grade, and TNM stage on survival of patients undergoing nephrectomy for RCC.

Several previous studies have indicated that increase in age has correlated with poor survival for RCC.[7] Jung et al. divided 619 patients with RCC into two groups according to the age at diagnosis, ≤55 or >55 years of age. The younger group had a greater 5-year survival rate than the older group (88.9% vs. 76.3%; P< 0.001).[8] However, this study did not find any association between age and survival rates of two groups, namely ≤55 and >55 years (P = 0.035).

Several studies indicate that tumor size is one of the most important prognostic factors of RCC. Some researchers have found that tumor size affects the prognosis of localized RCC, but it is not an independent prognostic factor. Usually, tumor size is associated with Fuhrman grade and histological classification, thus affecting the survival indirectly.[9] This study has found that 5-year survival is significantly different between the patients with tumor size of ≤7 cm and >7 cm (87.82% vs. 47.5%, P< 0.0001).

Fuhrman nuclear grade of RCC is an important prognostic factor.[10] Fuhrman et al. originally reported 5-year survival rates of 64%, 34%, 31%, and 10% for Grades I, II, III, and IV, respectively. This study observed that 5-year survival rates for low grades (1 and 2) and high grades (3 and 4) were 90.87% and 43.06%, respectively, which is statistically significant (P < 0.0001). This is consistent with the other studies and it emphasizes the importance of Fuhrman's nuclear grade in the evaluation of renal cancer prognosis.

The prognosis for patients with RCC primarily depends on disease stage. The organ-confined disease confers the best prognosis. For patients with locally advanced tumors, 5-year survival rates after nephrectomy decreased from 53% to 20%. For patients metastatic RCC, the 5-year survival rate is <10%. In this study, 5-year survival rate for stage P = 0.003).


 » Conclusion Top


This study has demonstrated the importance of factors such as tumor size, nuclear grade, and stage in the assessment of prognosis of RCC patients. More studies in India with more patients are needed to demonstrate the importance of these prognostic factors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1999. CA Cancer J Clin 1999;49:8-31.  Back to cited text no. 1
    
2.
Ljungberg B, Campbell SC, Cho HY, et al. The epidemiology of renal cell carcinoma. Eur Urol 2011;60:e29-36.  Back to cited text no. 2
    
3.
Chow WH, Devesa SS. Contemporary epidemiology of renal cell cancer. Cancer J 2008;14:288-301.  Back to cited text no. 3
    
4.
Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982;6:655-63.  Back to cited text no. 4
    
5.
GraphPad Prism 6. San Diego, CA, USA: Graph Pad Software Inc.; 2013. Available from: http://www.graphpad.com. [Last accessed on 2013 Sep 02].  Back to cited text no. 5
    
6.
Sun M, Shariat SF, Cheng C, Ficarra V, Murai M, Oudard S, et al. Prognostic factors and predictive models in renal cell carcinoma: A contemporary review. Eur Urol 2011;60:644-61.  Back to cited text no. 6
    
7.
Verhoest G, Veillard D, Guillé F, De La Taille A, Salomon L, Abbou CC, et al. Relationship between age at diagnosis and clinicopathologic features of renal cell carcinoma. Eur Urol 2007;51:1298-304.  Back to cited text no. 7
    
8.
Jung EJ, Lee HJ, Kwak C, Ku JH, Moon KC. Young age is independent prognostic factor for cancer-specific survival of low-stage clear cell renal cell carcinoma. Urology 2009;73:137-41.  Back to cited text no. 8
    
9.
Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: An analysis of pathological features related to tumor size. J Urol 2003;170(6 Pt 1):2217-20.  Back to cited text no. 9
    
10.
Kontak JA, Campbell SC. Prognostic factors in renal cell carcinoma. Urol Clin North Am 2003;30:467-80.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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