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Renal cell carcinoma: factors of importance for follow-up and survival
Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Renal cell carcinoma (RCC) is most lethal of the urological cancers, with more than 40% dying of the disease. About 30% of the patients have metastases at initial diagnosis and up to 40% undergoing nephrectomy for localized RCC develop metastasis. A follow-up protocol based on accurate prognostic variables allows identification of low and high risk patients and selection of those most likely to benefit from adjuvant therapy. I have studied a number of prognostic patient-related factors, including tumour stage and grade, angiogenetic factors and tumour markers, in order to improve follow-up guideline as well as to try to predict prognosis and clinical outcome for individual patients.

Material and Methods: The studies are based on patients treated for RCC between 1982 and 2002. All patients eligible for surgery with or without metastasis were treated with nephrectomy and were followed according to a scheduled follow-up programme. Serum samples were collected after obtained informed consent. Multiple clinicopathological, laboratory variables and preoperative radiological examinations were analyzed.

Results: Study I- After nephrectomy in 187 patients with non-metastatic RCC, 30% developed metastases during the follow-up. The risk for metastases was greater for more advanced stage and was adjusted by size and DNA ploidy. The median time to the diagnosis of metastases was 14.5 months. Metastases occurred in 43% of the patients within one year, within 2 years in 70% and 80% in 3 years. Patients with tumours less than 5 cm and diploid pT1>5cm and pT2 tumours survived longer than those with larger and aneuploid tumours. The 5-years survival rate for pT1, pT2, pT3 tumours were 95%, 87%, and 37% respectively. In pT3 tumours DNA ploidy had no relation to survival time.

Study II and IV- The median survival time for patients with metastatic RCC was 7 months. Cytoreductive nephrectomy was associated with longer survival time. Factors including performance status (PS), number of metastatic sites, erythrocyte sedimentation rate (ESR), calcium in serum, vein invasion, capsule invasion had independent prognostic value with Cox multivariate analysis. Study III- The incidence of adrenal tumour involvement was 5.3 %, unaffected of RCC type, tumour location or side. Gender (male) and locally advanced tumours (pT3 > 5cm) were factors predicting adrenal involvement. The presence of adrenal involvement was a significant adverse prognostic variable, indicating a significantly shorter survival in patients both with and without distant metastases.

Conclusion: Optimal follow-up guidelines are important from both medical and economic perspectives. The risk for progression depends mainly on stage, which in combination with other prognostic factors may allow more individualized and cost effective follow-up, in some cases by avoiding unnecessary examinations in a third of the patients. Cytoreductive nephrectomy in patients with good PS, metastases limited to one organ, low ESR, normal calcium and no vein invasion were factors associated to long survival time. Soluble angiogenic factors in serum gave no prognostic information. Ipsilateral adrenalectomy in conjunction with radical nephrectomy should be performed if an adrenal lesion cannot be cleared of suspicion during preoperative work up. Ipsilateral adrenal involvement is a highly adverse prognostic factor and should be staged as M1a in the TNM staging system.

Place, publisher, year, edition, pages
Umeå: Kirurgisk och perioperativ vetenskap , 2007. , 54 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1138
Keyword [en]
renal cell carcinoma, follow-up, VEGFR-1, PS, ESR, stage, prognosis, metastasis, surveillance, TNM classification, adrenalectomy, angiogenesis, VEGF
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:umu:diva-1418ISBN: 978-91-7264-439-7 (print)OAI: oai:DiVA.org:umu-1418DiVA: diva2:140971
Public defence
2007-11-23, E04, 6E, Norrlands universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2007-11-02 Created: 2007-11-02 Last updated: 2010-01-21Bibliographically approved
List of papers
1. Follow-up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy
Open this publication in new window or tab >>Follow-up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy
1999 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 84, no 4, 405-411 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-2716 (URN)
Available from: 2007-11-02 Created: 2007-11-02 Last updated: 2017-12-14Bibliographically approved
2. Factors of importance for prediction of survival in patients with metastatic renal cell carcinoma, treated with or without nephrectomy
Open this publication in new window or tab >>Factors of importance for prediction of survival in patients with metastatic renal cell carcinoma, treated with or without nephrectomy
2000 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 34, no 4, 246-251 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-2717 (URN)
Available from: 2007-11-02 Created: 2007-11-02 Last updated: 2017-12-14Bibliographically approved
3. Adrenal metastasis in renal cell carcinoma: a recommendation for adjustment of the TNM staging system.
Open this publication in new window or tab >>Adrenal metastasis in renal cell carcinoma: a recommendation for adjustment of the TNM staging system.
2005 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 39, no 4, 277-282 p.Article in journal (Refereed) Published
Keyword
Adrenal Gland Neoplasms/*secondary/surgery, Adrenalectomy, Adult, Aged, Aged; 80 and over, Carcinoma; Renal Cell/*secondary/surgery, Female, Humans, Kidney Neoplasms/*pathology/surgery, Male, Middle Aged, Neoplasm Staging, Nephrectomy, Survival Analysis
Identifiers
urn:nbn:se:umu:diva-14253 (URN)10.1080/003655905100077775 (DOI)16118103 (PubMedID)
Available from: 2007-05-25 Created: 2007-05-25 Last updated: 2017-12-14Bibliographically approved
4. Angiogenesis and other markers for prediction of survival in metastatic renal cell carcinoma.
Open this publication in new window or tab >>Angiogenesis and other markers for prediction of survival in metastatic renal cell carcinoma.
2007 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 41, no 1, 5-9 p.Article in journal (Refereed) Published
Keyword
Vascular endothelial growth factor, vascular endothelial growth factor receptor-1, basic fibroblast growth factor, erythropoietin, renal cell carcinoma, prognosis
Identifiers
urn:nbn:se:umu:diva-12222 (URN)doi:10.1080/00365590600830433 (DOI)17366095 (PubMedID)
Available from: 2008-01-08 Created: 2008-01-08 Last updated: 2017-12-14Bibliographically approved

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