Clinicopathological features and surgical management of sporadic bilateral renal cell carcinoma

Abstract

Objective To investigate the clinicopathological features, the efficacy of surgical strategies and the prognostic factors of sporadic bilateral renal cell carcinoma. Methods A total of 79 patients treated from January 2006 to December 2013 were included in the retrospective study. Of the 79 patients, 56 were males, 23 were females; the mean age was 52 (25-74) years. Sixty-four were bilateral synchronous renal cell carcinoma and 15 were bilateral metachronous renal cell carcinoma, none of these cases had family history. Clinical stages were T1 in 68 cases, T2 in 8 cases, T3 in 3 cases. Results All of the 79 patients underwent bilateral surgeries, of which bilateral nephron-sparing surgery (NSS) was performed in 34 (43.0%) patients, NSS-radical nephrectomy (RN) in 37 (46.8%), RN-radio-frequency ablation (RFA) in 6 (7.6%), NSS-RFA in 1 (1.3%), and bilateral RN in 1 (1.3%). There were 184 tumors in the 79 patients. Of the 171 tumors with pathological results, 158 (92.4%) tumors were clear cell subtype, 7 (4.1%) papillary, 4 (2.3%) chromophobe and 2 (1.2%) sarcoid. Bilateral clear cell renal cell carcinoma was found in 55 patients and bilateral papillary renal cell carcinoma in 2 patients. Fifteen patients presented with multifocal tumors in one kidney. Seventy-seven (97.5%) patients were followed up and the median follow up period was 49 (9-150) months. In the most recent follow up, 59 (76.6%) patients survived without tumors, 9 (11.7%) patients survived with tumors, 9 (11.7%) patients died. The 3-year overall survival rate and 3-year progress free survival rate were 89.8% and 87.1%, respectively. The higher nuclear grade and higher T stage were related to worse prognosis with the P=0.005 and P=0.022 in multivariate analysis, respectively. Bilateral NSS did not increase the risk of disease progress (P=0.157). Conclusions Clear cell carcinoma is the main subtype of bilateral sporadic renal carcinoma. NSS is the preferred choice for bilateral kidney tumors. Patients with sporadic bilateral renal tumors underwent active surgeries on both kidneys could get comparable oncological results with that of patients with unilateral renal tumors. Key words: Kidney neoplasms; Bilateral; Sporadic; Surgical procedures, operative