|Year : 2018 | Volume
| Issue : 3 | Page : 297-300
Comparative study of renal cell carcinoma in patients less than 40 years of age and older age patients: A retrospective single-center study
Dilip Kumar Pal, Arun Kumar Maurya, Debarshi Jana
Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
|Date of Web Publication||28-Jan-2019|
Dilip Kumar Pal
Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
BACKGROUND: Renal cell carcinoma (RCC) is typically found in the older age group between 50 and 70 years of age. However, diagnosis of renal cancer is increasing more rapidly in patients less than 40 years if age compared to older age patients. AIMS AND OBJECTIVES: To compare the clinicopathological spectrum and survival in patients with RCC in relation to age in a tertiary care hospital in eastern India. STUDY DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Patients operated between February 2008 and January 2017 for renal masses having clinical and radiological suspicion and histopathologically proven RCC were analyzed from hospital records. Clinicopathological data and survival study were compared between patients less than 40 years of age and older age patients. STATISTICAL ANALYSIS USED: Statistical and survival analysis was done using Statistical Package for the Social Sciences 20. RESULTS: Among 198 patients, 36 (18.2%) patients less than 40 years were diagnosed with RCC and 162 in older patients. In these 36 younger patients, 17 (47.2%) were male and 19 (52.7%) were female. A total of 63.8% in younger age group and 69.1% of older patients were diagnosed with stage 1 and 2 RCC; comparing younger to older patients, younger patients had high number of papillary carcinoma (22.2% vs. 11.7%, P = 0.096). Younger patients have shown marginally better 5-year overall survival and disease-free survival (P > 0.05). CONCLUSION: Our study concludes that younger age patients were more affected by RCC specially papillary RCC, when compared to western population. In addition females had more incidence of RCC. Prognosis was similar in both groups.
Keywords: Clear-cell carcinoma, renal cell carcinoma, survival, young adult
|How to cite this article:|
Pal DK, Maurya AK, Jana D. Comparative study of renal cell carcinoma in patients less than 40 years of age and older age patients: A retrospective single-center study. Indian J Cancer 2018;55:297-300
|How to cite this URL:|
Pal DK, Maurya AK, Jana D. Comparative study of renal cell carcinoma in patients less than 40 years of age and older age patients: A retrospective single-center study. Indian J Cancer [serial online] 2018 [cited 2019 Apr 26];55:297-300. Available from: http://www.indianjcancer.com/text.asp?2018/55/3/297/250899
| » Introduction|| |
Renal cell carcinoma (RCC) accounts for 2%–3% of all adult malignant neoplasm. It is mainly found in patients of older age group, and the typical age of presentation is between 50 and 70 years of age. However, diagnosis of renal cancer is increasing more rapidly in patients less than 40 years of age when compared with older age patients. Landmark for less than 40 years age as younger patient was based on previous studies on early-onset colon and breast cancers at or before 40 years of age, suggesting differences in the natural history of these cancers for young patients., To the best of our knowledge, none of the studies has been conducted so far with respect to eastern Indian database for younger age presentation of RCC and its relation with clinicopathological and survival characteristics. The aim of this study was to fill this lacuna.
| » Materials and Methods|| |
From February 2008 to January 2017, patients with renal masses with clinical and radiological suspicion of malignancy who were operated at our institute were analyzed. Data was collected from patient case-records and from the oncology register of the department. Patients who were >12 years of age and histopathologically proven RCC were included in the study. Patients with benign or malignant tumors other than RCC and those with known von Hippel–Lindau disease were excluded. Variable studies were gender, tumor size, TNM stage, Fuhrman grade, histopathological subtypes, lymph node involvement, inferior vena cava thrombus, and survival. Staging and grading were done according to an updated staging system by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer., Patients were regularly followed up in outpatient department according to staging and as per protocol. Patients who had documented metastatic disease following nephrectomy and died of unknown causes were considered to have died from RCC. Patients who died from unknown causes and having no documentation of metastatic disease were censored while evaluating cancer-specific survival. Follow-up duration was started from the date of surgery to the last follow-up or date of death.
For statistical analysis, data were entered into a Microsoft Excel spreadsheet and then analyzed by Statistical Package for the Social Sciences 20.0.1 and Graph Pad Prism version 5. Data had been summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Student's independent sample's t-test was applied to compare normally distributed numerical variables between groups; unpaired proportions were compared by Chi-square test or Fisher's exact test, as appropriate. Z-test (standard normal deviate) was used to test the significant difference between two proportions. Kaplan–Meier estimator (Kaplan–Meier survival analysis) was a nonparametric statistic used to estimate the survival function from time data. P value ≤0.05 was considered for statistically significant.
| » Results|| |
During the study period, a total of (n) 198 patients were admitted with histopathologically proven RCC. None of the patients had bilateral tumor. Of 198, 36 (18.2%) patients were found to be 40 years or below [Table 1]. The mean age of presentation of these 36 patients was 35.5 years (median 37, range 12–40 years). Among 36 patients, 17 (47.2%) were male and 19 (52.7%) were female. Our study revealed that male-to-female ratio in both our study groups were significantly different (male-to-female ratio 0.89 vs. 2.8; P < 0.0001); histopathologically, patients <40 years of age were found to have been presented with more advanced pTNM stage (pT1–2N0M0, 63.8% vs. 69.1%) and also were found to have more papillary tumors (22.2% vs. 11.7%) as per histopathology (all were type 1 papillary tumors). There were no statistical differences in the rate of symptomatic patients, clear-cell carcinomas' histology, microscopic vascular invasion, or Fuhrman nuclear grade.
In younger group (<40 years), five patients died and two patients were lost to follow-up. The total follow-up duration in our study was between 6 and 108 months. As per our analysis, the younger age group patients have better overall and 5-year survival, but it was statistically insignificant [Table 2] and [Figure 1], [Figure 2]. There were similar findings in disease-free survival in both the age groups of patients without reaching significance threshold (75.0% vs. 66.7%, P = 0.339) [Table 3] and [Figure 3], [Figure 4].
|Table 2: Overall survival of patients in different stages of renal cell carcinoma|
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|Figure 1: Kaplan–Meier curve showing overall 5-year survival in <40 years age group (all stages); there is no mortality in stage 1|
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|Figure 2: Kaplan–Meier curve showing overall 5-year survival in >40 years age group (all stages)|
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|Table 3: Disease-free survival of patients in different stages of renal cell carcinoma|
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|Figure 3: Kaplan–Meier curve showing disease-free 5-year survival in <40 years age group|
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|Figure 4: Kaplan–Meier curve showing disease-free 5-year survival in >40 years age group|
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| » Discussion|| |
RCC is a disease of elderly population. Although data from a developing country like India are lacking. To our best knowledge, this is the first study carried out in the eastern part of India addressing this issue. Epidemiological data from the West have shown that around 3.4%–7.5% of patients with renal tumor were less than 40 years of age,, while in our study 18.% of patients were below the age of 40 years.
In western countries, more than 80% of the RCC has been reported to present as organ-confined (T1 + T2N0M0) disease; but in our study (63.8%), 135 patients (68.1%) had T1 and T2 which again signifies the higher stage of presentation.
In our study where patients ≤40 years of age were observed, the male-to-female ratio was found to be 1:1.2, which showed female predominance. Various other studies have also shown similar lower male-to-female ratio among patients less than 40 years of age., This difference in sex ratio could be due to difference in treatment-seeking behavior looking at limited financial resources in a developing country like India.
Literature from developed countries showed that RCC in children and young adults is more likely to be symptomatic, confined to kidney, and of high grade.,,, Our study also showed that younger patients were more symptomatic than older ones (75.5% vs. 61.1%) and of higher tumor grade (Fuhrman nuclear grade III + IV, 33.3% vs. 28.34%, P = 0.555) though both the results were not statistically significant. Clear-cell RCC is the most common histological subtype among all RCCs formerly known as “conventional” RCC, which accounts for 70%–80% of all RCCs., Our study also showed the same result for clear-cell RCC in both the age groups but we found more patients with papillary RCC in younger age group than older age group (22.2% vs. 11.7%, P = 0.096).
Although in younger age group our study showed better overall survival and progression-free survival, the results were statistically insignificant, P = 0.122 and P = 0.339. Similar findings were found in the western literature., Various studies showed that a deleterious change in tumor biology may have occurred during the past several decades, perhaps related to tobacco use, obesity, or exposure to other carcinogens. These deleterious changes could have lead to different biological host–tumor relationship between the two age groups causing difference in survival.
| » Conclusion|| |
Our study showed that a higher number of younger patients were diagnosed with RCC, with a female predominance, and also, the prognosis appears similar between the two age groups.
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Conflicts of interest
There are no conflicts of interest.
| » References|| |
Pantuck AJ, Zisman A, Belldegrun AS. The changing natural history of renal cell carcinoma. J Urol 2001;166:1611-23.
Nepple KG, Yang L, Grubb RL 3rd
, Strope SA. Population based analysis of the increasing incidence of kidney cancer in the United States: Evaluation of age specific trends from 1975 to 2006. J Urol 2012;187:32-8.
Behbehani A, Sakwa M, Ehrlichman R, Maguire P, Friedman S, Steele GD Jr., et al.
Colorectal carcinoma in patients under age 40. Ann Surg 1985;202:610-4.
Chung M, Chang HR, Bland KI, Wanebo HJ. Younger women with breast carcinoma have a poorer prognosis than older women. Cancer 1996;77:97-103.
Edge SB, Compton CC. The American Joint Committee on Cancer: The 7th
edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010;17:1471-4.
Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982;6:655-63.
Kantor AL, Meigs JW, Heston JF, Flannery JT. Epidemiology of renal cell carcinoma in Connecticut, 1935-1973. J Natl Cancer Inst 1976;57:495-500.
Taccoen X, Valeri A, Descotes JL, Morin V, Stindel E, Doucet L, et al.
Renal cell carcinoma in adults 40 years old or less: Young age is an independent prognostic factor for cancer-specific survival. Eur Urol 2007;51:980-7.
Thompson RH, Ordonez MA, Iasonos A, Secin FP, Guillonneau B, Russo P, et al.
Renal cell carcinoma in young and old patients – Is there a difference? J Urol 2008;180:1262-6.
Sánchez-Ortiz RF, Rosser CJ, Madsen LT, Swanson DA, Wood CG. Young age is an independent prognostic factor for survival of sporadic renal cell carcinoma. J Urol 2004;171:2160-5.
Estrada CR, Suthar AM, Eaton SH, Cilento BG Jr. Renal cell carcinoma: Children's hospital Boston experience. Urology 2005;66:1296-300.
Cook A, Lorenzo AJ, Salle JL, Bakhshi M, Cartwright LM, Bagi D, et al.
Pediatric renal cell carcinoma: Single institution 25-year case series and initial experience with partial nephrectomy. J Urol 2006;175:1456-60.
Störkel S, Eble JN, Adlakha K, Amin M, Blute ML, Bostwick DG, et al.
Classification of renal cell carcinoma: Workgroup no 1. Union Internationale Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer 1997;80:987-9.
Deng FM, Melamed J. Histologic variants of renal cell carcinoma: Does tumor type influence outcome? Urol Clin North Am 2012;39:119-32, v.
Gillett MD, Cheville JC, Karnes RJ, Lohse CM, Kwon ED, Leibovich BC, et al.
Comparison of presentation and outcome for patients 18 to 40 and 60 to 70 years old with solid renal masses. J Urol 2005;173:1893-6.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]