Abstract
Purpose
Age has been linked to outcome in renal cancer patients, but mainly in North American cohorts. In this study, we hypothesized that age is correlated with metastasis and cancer-specific survival in a German cohort regardless of types of treatments.
Methods
A total of 1,538 patients treated for renal malignancies between 1991 and 2010 were evaluated. Mean age and median age are 61.9 ± 11.6 and 62.6 years. Clinicopathologic [tumor type, size, grade, stage and treatment (surgery, chemotherapy, radiation, immunotherapy)] and outcome parameters (metastasis and survival) were examined for an association with age using logistic regression and Cox proportional hazard model, and Kaplan–Meier plots.
Results
Age was associated with stage, metastasis, treatment, cancer-specific and overall mortality (p < 0.01). The metastasis-free and cancer-free survival rates for patients >63 years were lower than those for patients ≤63 years (p < 0.0001). In a multivariate analysis, age was an independent prognostic factor of metastasis, cancer-specific and overall mortality (p < 0.0001) even when data were stratified in different decades and treatment was included as one of the parameters. Patients >63 years of age had 29–35 % higher risk of metastasis and cancer-specific mortality than younger patients. Median metastasis-free and cancer-specific survival for patients >63 years of age (months: 84.4; 70.3) was ~50 % shorter than in patients ≤63 years (months: 151; 144.6).
Conclusions
This large study shows that, despite advances in surgical and non-surgical treatment modalities over the two decades, age is an independent prognostic indicator of metastasis and cancer-specific mortality in renal cancer patients. Patients >63 years have ~30 % increased risk for metastasis and ~50 % shorter cancer-specific survival.
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References
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer. http://globocan.iarc.fr. Accessed 20 Aug 2013
Cohen HT, McGovern FJ (2005) Renal-cell carcinoma. N Engl J Med 353:2477–2490
Chow WH, Devesa SS (2008) Contemporary epidemiology of renal cell cancer. Cancer J 14:288–301
Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr (1999) Rising incidence of renal cell cancer in the United States. JAMA 281:1628–1631
Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK (2006) Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 98:1331–1334
Sun M, Thuret R, Abdollah F, Lughezzani G, Schmitges J, Tian Z, Shariat SF, Montorsi F, Patard JJ, Perotte P, Karakiewicz PI (2011) Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis. Eur Urol 59:135–141
Jayson M, Sanders H (1998) Increased incidence of serendipitously discovered renal cell carcinoma. Urology 51:203–205
Nepple KG, Yang L, Grubb RL 3rd, Strope SA (2012) Population based analysis of the increasing incidence of kidney cancer in the United States: evaluation of age specific trends from 1975 to 2006. J Urol 187:32–38
Behbehani A, Sakwa M, Ehrlichman R, Maguire P, Friedman S, Steele GD Jr, Wilson RE (1985) Colorectal carcinoma in patients under age 40. Ann Surg 202:610–614
Delaloye JF, Pampallona S, Coucke PA, De Grandi P (1996) Younger age as a bad prognostic factor in patients with carcinoma of the cervix. Eur J Obstet Gynecol Reprod Biol 64:201–205
Falvo L, Catania A, Sorrenti S, D’Andrea V, Berni A, De Stefano M, De Antoni E (2004) Prognostic significance of the age factor in the thyroid cancer: statistical analysis. J Surg Oncol 88:217–222
Pectasides D, Fountzilas G, Aravantinos G, Bamias A, Kalofonos HP, Skarios D, Briasoulis E, Konstantara A, Economopoulus T, Dimopoulos MA (2007) Epithelial ovarian carcinoma in younger vs older women: is age an independent prognostic factor? The Hellenic Oncology Cooperative Group experience. Int J Gynecol Cancer 17:1003–1010
Volpe A, Patard JJ (2010) Prognostic factors in renal cell carcinoma. World J Urol 28:319–327
Wittekind C, Meyer HJ (eds) (2010) TNM-Klassifikation Maligner Tumoren, 7th edn. Wiley-Blackwell, Weinheim
Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663
Wahlgren T, Harmenberg U, Sandström P, Lundstam S, Kowalski J, Jakobsson M, Sandin R, Ljungberg B (2013) Treatment and overall survival in renal cell carcinoma: a Swedish population-based study (2000–2008). Br J Cancer 108:1541–1549
Rampersaud EN, Klatte T, Bass G, Patard JJ, Bensaleh K, Böhm M, Allhoff EP, Cindolo L, De La Taille A, Mejean A, Soulie M, Bellec L, Christophe Bernhard J, Pfister C, Colombel M, Belldegrun AS, Pantuck AJ, George D (2013) The effect of gender and age on kidney cancer survival: Younger age is an independent prognostic factor in women with renal cell carcinoma. Urol Oncol. doi:10.1016/j.urolonc.2012.10.012. [Epub ahead of print]
Verhoest G, Veillard D, Guille F, de la Taille A, Salomon L, Abbou CC, Valeri A, Lechevallier E, Descotes JL, Lang H, Jacqmin D, Tostain J, Cindolo L, Ficarra V, Artibani W, Schips L, Zigeuner R, Mulders PF, Mejean A, Patard JJ (2007) Relationship between age at diagnosis and clinicopathologic features of renal cell carcinoma. Eur Urol 51:1298–1304; discussion 1304–1305
Taccoen X, Valeri A, Descotes JL, Morin V, Stindel E, Doucet L, Joulin V, Bocqueraz F, Coulange C, Rambeaud JJ, Fournier G, Mejean A, Oncology Committee of the Association Francaise d’Urologie (2007) Renal cell carcinoma in adults 40 years old or less: young age is an independent prognostic factor for cancer-specific survival. Eur Urol 51:980–987
Sanchez-Ortiz RF, Rosser CJ, Madsen LT, Swanson DA, Wood CG (2004) Young age is an independent prognostic factor for survival of sporadic renal cell carcinoma. J Urol 171:2160–2165
Kates M, Korets R, Sadeghi N, Pierorazio PM, McKiernan JM (2012) Predictors of locally advanced and metastatic disease in patients with small renal masses. BJU Int 109:1463–1467
Nelson RA, Vogelzang N, Pal SK (2013) A gap in disease-specific survival between younger and older adults with de novo metastatic renal cell carcinoma: results of a SEER database analysis. Clin Genitourin Cancer. doi:10.1016/j.clgc.2013.04.011
Jeong IG, Yoo CH, Song K, Park J, Cho YM, Song C, Hong JH, Ahn H, Kim CS (2009) Age at diagnosis is an independent predictor of small renal cell carcinoma recurrence-free survival. J Urol 182:445–450
Mason RJ, Abdolell M, Trottier G, Pringle C, Lawen JG, Bell DG, Jewett MA, Klotz L, Rendon RA (2011) Growth kinetics of renal masses: analysis of a prospective cohort of patients undergoing active surveillance. Eur Urol 59:863–867
Sun M, Abdollah F, Bianchi M, Trinh QD, Jeldres C, Tian Z, Shariat SF, Widmer H, Zorn K, Menon M, Montorsi F, Perrotte P, Karakiewicz PI (2011) A stage-for-stage and grade-for-grade analysis of cancer-specific mortality rates in renal cell carcinoma according to age: a competing-risks regression analysis. Eur Urol 60:1152–1159
Karakiewicz PI, Suardi N, Capitanio U, Jeldres C, Ficarra V, Cindolo L, de la Taille A, Tostain J, Mulders PF, Bensalah K, Artibani W, Salomon L, Zigeuner R, Valeri A, Descotes JL, Rambeaud JJ, Mejean A, Montorsi F, Bertini R, Patard JJ (2009) A preoperative prognostic model for patients treated with nephrectomy for renal cell carcinoma. Eur Urol 55:287–295
Cloutier V, Capitanio U, Zini L, Perrotte P, Jeldres C, Shariat SF, Arjane P, Patard JJ, Montorsi F, Karakiewicz PI (2009) Thirty-day mortality after nephrectomy: clinical implications for informed consent. Eur Urol 56:998–1003
Acknowledgments
Support in terms of collection and management of the data was provided by the Clinical Cancer Registry of the Medical School Hannover. Marie C. Hupe was supported by fellowship from the Hannover Biomedical Research School, StrucMed Program. She was a fellow of the International Academy of Life Sciences, Biomedical Exchange Program in Dr. Vinata Lokeshwar’s laboratory.
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The authors declare that they have no conflict of interest.
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Marie C. Hupe and Axel S. Merseburger have contributed equally and are joint first authors.
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Hupe, M.C., Merseburger, A.S., Lokeshwar, V.B. et al. Age—an independent prognostic factor of clinical outcome in renal malignancies: results of a large study over two decades. World J Urol 32, 115–121 (2014). https://doi.org/10.1007/s00345-013-1164-6
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DOI: https://doi.org/10.1007/s00345-013-1164-6