Predictive parameters of metastatic renal cell cancer

Česká verzia

Authors: Roman Sobotka; Otakar Čapoun; Viktor Soukup; Tomáš Hanuš
Authors place of work: Urologická klinika 1. LF UK a VFN, Praha
Published in the journal: Ces Urol 2014; 18(2): 101-111
Category: Original article

Summary

The goal of this study was to define clinical and laboratory parameters for metastatic renal cell carcinoma (RCC) in patients indicated for surgery.

A total of 218 patients underwent surgery for kidney tumors from May 2008 to February 2012. Age, sex, smoking history, body mass index, clinical symptoms, and selected laboratory and perioperative parameters were recorded for all patients. Histological examination included the type and tumor size, grade, and other histological findings. The significance of each parameter was evaluated using a nonparametric ANOVA (Wilcoxon test). The relative risk was assessed using a regression model to generalize the tumor. Multivariate analysis was performed using the Cox regression model.

The average age of the patients was 64 years old (22–84), 143 (66%) were males, and 62 (28%) were smokers. The mean BMI was 30.0 (19.1 to 45.2). Incidentally found RCC was described in 155 (71%) cases. Primary metastatic RCC was found in 36 (17%) patients. A total of 65 (30%) patients underwent kidney resection, 21 (32%) of which were performed laparoscopically. A benign tumor was diagnosed in 20 (9%) patients, with the most common cancer being clear cell RCC (72%). Statistically significant parameters for metastatic RCC were weight loss, CRP level, thrombocytosis, tumor size, and presence of symptoms (p < 0.0001), hemoglobin level (p = 0.0003), tumor grade (p = 0.0004), pT classification (p = 0.0006) and neutrophilia (p = 0.0239). Incidentally found tumour was a favorable parameter for localized tumor stage (p < 0.0001). Benign tumors were more frequently diagnosed in women (p = 0.0204). Blood loss, operating time, and duration of hospitalization were significantly different between open and laparoscopic procedures.

Many clinical and histological parameters showed a statistically significant difference, predicting a generalized RCC. The risk of metastatic RCC in patients with CRP > 15 ng/ml is 22 times higher, with hemoglobin < 120 g/l, 4.5 times higher with platelets above 350 × 10⁹ 9times, and with tumors above 9 cm in size it was 7–6 times higher.

Key words:
renal cell cancer, metastasis, tumor marker, prognostic factors, CRP.

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