Long-term survival in renal cell cancer patients (Pehmeäkantinen kirja)

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The object of this study was to investigate the long-term prognosis and prognostic factors, symptoms and change in diagnostics among renal cell carcinoma (RCC) patients diagnosed in the Pirkanmaa region. To this end, we collected information from the original medical records of 970 RCC patients diagnosed between 1963 and 1997. Follow-up was up to August 2007, the longest follow-up being 35 years.

RCC is a rare disease. During 2011, according to the most recent statistics in the Finnish Cancer Registry, new cases of kidney cancer were diagnosed in 415 females and 562 males nationwide. Of these, 42 females and 43 males were diagnosed in the Pirkanmaa Hospital District. Almost 40 years has passed since the last publication on the clinical presentation of RCC in Finland. Apart from this, we found no data on the current symptoms of RCC in the international literature. This lack of information prompted us to collect the present material. RCC involves poor long-term survival. Here primarily metastatic disease was found in 26% of patients and 30% relapsed during follow-up, some of these even after a 20-year disease-free period. After 25 years only 26% of patients were alive.

Fifty per cent of operated women and 43% of operated men remained disease-free; 47% of all women and 54% of all men died of RCC. Stage, age and symptomatic disease were the most important clinical prognostic factors. Also grade, gender, smoking status and body mass index (BMI) were significant. In terms of the order of importance of clinical factors, the clinical presentation proved a stronger prognostic factor than BMI. Obese patients had better survival (5.9 years) than normal or underweight patients (3.4 years and 12 months, respectively) with lower-stage, asymptomatic tumors. Smokers had poorer survival in localized tumors than non-smokers; in stage I tumors five-year overall survival was 71% vs. 89%, respectively. In cancer-spesific survival there was no difference between smoking status groups, even though smokers had more relapses and a shorter disease-free interval. There was no difference in patient-dependent delay. We found no other explanatory factors for recurrent disease than the smoking itself.
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