Changing prognosis of renal cell carcinoma: a single-centre experience over 25 years

Abstract

Objective:

The objective of this research is to examine renal cancer nephrectomies over 25 years in our centre and the factors underlying changes in disease-specific survival.

Patients and methods:

Retrospective data analysis was performed on all patients undergoing nephrectomies at our institution for renal cell carcinoma (RCC) from 1983 to 2007. Data extracted from the Cancer Research Uro-Oncology Database (CRUD©) provided survival, clinical and prognostic information including tumour diameter, Fuhrman grade, WHO staging and age.

Results:

Analysis of 664 RCCs demonstrated a clear change in kidney cancer-specific survival over the past 25 years, with five-year survival improving from 42% (1983–1986) to 73% (1999–2002). The number of RCC nephrectomies has increased 10 fold. There was no significant change in operative mortality, age, grade, stage or mean tumour size. However, there was a five-fold increase in tumours <6 cm, corresponding to an equal-fold decrease in tumours 6–8 cm, but no change in tumours >8 cm. Tumour size >8 cm was a significant adverse prognostic marker.

Conclusions:

A 30% improvement in RCC cancer-specific survival has been seen in our centre over the last 25 years. This change relates to a shift to smaller tumours, lower histological grades and a higher volume of cases.