A prospective database of 968 patients with renal cell carcinoma (RCC) surgically managed at MSKCC between 7/1/89 to 12/31/99 is reported. Due to the liberal application of modern abdominal imaging for non-specific complaints, the incidental detection of renal tumors rose to 69% in 1999. The median tumor size significantly decreased from 8.1 cm in 1989 to 4.8 cm in 1999 with a corresponding increase in pathologic P1 tumors from 28% in 1989 to 71% in 1999. Overall actuarial disease-free survival at 5 years was 77%. We now understand that RCC is not one disease but several distinct histologic subtypes with varying prognoses. The conventional or clear cell tumors comprise 66%, the papillary tumors 14 %, oncocytoma 10%, chromophobe 8%, unclassified 1.7%. The prognosis of clear cell and unclassified tumors is significantly worse than papillary and chromophobe variants (p=0.0001), which in turn are significantly worse than the virtually benign oncocytomas (p=0.026). Because of the earlier detection of smaller tumors, the application of nephron sparing surgery or partial nephrectomy has increased at our center from 8% in 1989 to 39% in 1999. There are no significant differences in survival or local recurrence for tumors 4 cm or less in diameter whether partial or radical nephrectomy is performed. In more advanced cases of renal cancer, the therapeutic impact of resecting metastatic regional lymph nodes, metastatic adrenal glands, or local recurrence is negligible. A post-operative nomogram has been developed that is effective in predicting poor prognostic patients that would be eligible for clinical trials.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will understand that renal cell carcinoma is not one disease but several distinct histologic subtypes with varying prognoses which have specific implications for primary treatment decisions and surveillance posttreatment. A post-operative nomogram is effective in predicting poor prognostic patients
Keywords: Cancer, Disease Management
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.