Prognostic factors in patients with renal cell carcinoma
- Toni K Choueiri, MD
Toni K Choueiri, MD
- Director, The Lank Center for Genitourinary Oncology
- Dana-Farber Cancer Institute and Brigham and Women's Hospital
- Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
- Michael B Atkins, MD
Michael B Atkins, MD
- Section Editor — Malignant Melanoma and Other Cutaneous Neoplasms; Cancer of the Kidney
- Deputy Director
- Georgetown Lombardi Comprehensive Cancer Center
Renal cell carcinomas (RCCs), which originate within the renal cortex, constitute 80 to 85 percent of primary renal neoplasms. Urothelial (transitional cell) carcinomas of the renal pelvis account for approximately 8 percent of kidney tumors, and other parenchymal epithelial tumors, such as oncocytomas, collecting duct tumors, and renal sarcomas, are rare. Nephroblastoma (Wilms' tumor) is common in children (5 to 6 percent of primary renal tumors). (See "Epidemiology, pathology, and pathogenesis of renal cell carcinoma" and "Malignancies of the renal pelvis and ureter".)
When patients with RCC present with localized disease, surgical resection can be curative. Unfortunately, many RCCs are clinically silent for much of their natural history. Thus, the diagnosis is frequently not made until disease is either locally advanced and unresectable or metastatic. Furthermore, many patients who initially are resectable eventually recur. The prognosis for long-term disease-free survival for patients with locally advanced or metastatic RCC is generally poor.
The factors affecting prognosis in patients with RCC will be reviewed here. An overview of the approach to treatment is presented separately. (See "Overview of the treatment of renal cell carcinoma".)
ANATOMIC EXTENT OF DISEASE
The Tumor, Nodes, Metastasis (TNM) staging system is used to assess the anatomic extent of disease (table 1) . The anatomic extent of disease is the most consistent factor that influences prognosis in patients with renal cell carcinoma (RCC) (figure 1). (See "Clinical manifestations, evaluation, and staging of renal cell carcinoma", section on 'TNM staging system'.)
Stage I/II — Patients with stage I RCC have a five-year survival rate over 90 percent in most contemporary series. The survival rate may be slightly lower for patients with stage II disease, with reported five-year survival rates ranging from 75 to 95 percent.
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