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J Urol. 2014 Feb;191(2):310-5. doi: 10.1016/j.juro.2013.08.021. Epub 2013 Aug 20.

Do young patients with renal cell carcinoma feature a distinct outcome after surgery? A comparative analysis of patient age based on the multinational CORONA database.

Author information

1
Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany.
2
Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany.
3
Department of Urology, Medical University of Graz, Graz, Austria.
4
Department of Urology, Pio Da Pietrelcina Hospital, Vasto, Italy.
5
Division of Urology, European Institute of Oncology, Milan, Italy.
6
Department of Urology, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
7
Department of Urology, Faculty of Health Sciences, University "La Sapienza", Ospedale Sant'Andrea, Rome, Italy.
8
Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania.
9
Department of Urology, Klinikum Dortmund, Dortmund, Germany.
10
Department of Urology, Klinikum Dortmund, Dortmund, Germany; Department of Urology, Medical University of Graz, Graz, Austria.
11
Department of Urology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany.
12
Department of Urology, Emergency Hospital Satu Mare, Satu Mare, Romania.
13
Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri.
14
Department of Urology, Hospital Universitario Principe de Asturias, Alcala de Henares, Madrid, Spain.
15
Department of Urology, G. Rummo Hospital, Benevento, Italy.
16
Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Munich, Germany.
17
Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Munich, Germany. Electronic address: sabine.brookman-may@email.de.

Abstract

PURPOSE:

We analyzed the distinct clinicopathological features and prognosis of patients with renal cell carcinoma age 40 years or less compared to a reference group of patients 60 to 70 years old.

MATERIALS AND METHODS:

Overall 2,572 patients retrieved from a multicenter international database comprised of 6,234 patients with surgically treated renal cell carcinoma were included in this retrospective study. Clinical and histopathological features of 297 patients 40 years old or younger (4.8%) were compared to those of 2,275 patients (36.5%) 60 to 70 years old, who served as the reference group. Median followup was 59 months. The impact of young age and further parameters on disease specific mortality and all cause mortality was evaluated by multivariate Cox proportional hazards regression analyses.

RESULTS:

Young patients more frequently underwent nephron sparing surgery (27% vs 20%, p = 0.008) and regional lymph node dissection compared to older patients (38% vs 32%, p = 0.025). Organ confined tumor stage (81% vs 70%, p <0.001), smaller tumor diameter (4.5 vs 4.7 cm, p = 0.014) and chromophobe subtype (10% vs 4%, p <0.001) were significantly more frequent in young patients. On multivariate analysis older patients had a higher disease specific (HR 2.21, p <0.001) and all cause mortality (HR 3.05, p <0.001). The c indices for the Cox models were 0.87 and 0.78, respectively. However, integration of the variable age group did not significantly increase the predictive accuracy of the disease specific and all cause mortality models.

CONCLUSIONS:

Young patients with renal cell carcinoma (40 years old or younger) have significantly different frequencies of clinical and histopathological features, and a significantly lower all cause and disease specific mortality compared to patients 60 to 70 years old.

KEYWORDS:

LND; NSS; RCC; age factors; carcinoma; lymph node dissection; neoplasms by histologic type; nephrectomy; nephron sparing surgery; outcome assessment; renal cell; renal cell carcinoma

PMID:
23973516
DOI:
10.1016/j.juro.2013.08.021
[Indexed for MEDLINE]

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