Can symptoms predict the prognosis of renal cell carcinoma? A multivariate analysis of 320 patients

Abstract

The well-known, classical symptoms of renal cell carcinoma (RCC) are abdominal or flank pain, a palpable mass, and hematuria. However, the number of patients with this classical triad has been decreasing recently. This is especially true in Japan where health screening programs detect many incidental renal cell carcinomas. This study reevaluated the presenting symptoms of RCC as prognostic factors. It also showed that patients found to have RCC by health screening had a significantly low hazard ratio and a good prognosis. To evaluate the presenting symptoms as prognostic factors for survival, we retrospectively studied 320 patients with renal cell carcinoma between 1978 and 1995. The following symptoms were evaluated as prognostic factors: large amount of hematuria, any hematuria (including microscopic and macroscopic), flank and/or abdominal pain, a palpable mass, malaise, weight loss, pyrexia, and the reason for examining the kidneys. Survival curves were calculated by the Kaplan-Meier method, and univariate analysis was performed using the log-rank test and Cox's proportional hazard model. Significant factors were then chosen for Cox's multivariate proportional hazard test to evaluate their relative prognostic value. The median follow-up period was 29 months. The overall survival rate at 1, 5, and 10 years was 90.0%, 77.6%, and 69.9%, respectively. The chi-square test revealed a close relationship between flank and/or abdominal pain and local tumor extent; pyrexia and lymph node and distant metastasis; and incidental detection by health screening with no local invasion or distant metastasis. Of the 8 prognostic factors evaluated, univariate and multivariate analysis showed that flank and/or abdominal pain and pyrexia were poor prognostic factors, while patients with tumors found by routine health screening or during workup of other diseases showed a good outcome.