Incidental renal cell carcinoma—age and stage characterization and clinical implications: study of 1092 patients (1982–1997)

doi:10.1016/S0090-4295(00)00534-3

Urology

Volume 56, Issue 1, July 2000, Pages 58-62

https://doi.org/10.1016/S0090-4295(00)00534-3 Get rights and content

Abstract

Objectives. To compare the epidemiologic, clinical, and pathologic characteristics of incidental and symptomatic renal cell carcinoma in a large series of patients, with emphasis on age distribution and its potential impact in defining groups of patients that may benefit from early detection programs.

Methods. Records of 1092 patients with renal tumors from 1982 to 1997 were reviewed. Age, clinical presentation, and pathologic stage and grade were analyzed. Special attention was given to the age distribution and its relationship to the incidental or symptomatic diagnosis.

Results. The overall mean age and proportion of patients older than 65 gradually increased (from 57 to 62.6 years and from 24.7% to 48.7%, respectively) from 1982 to 1997. The mean age in the incidental group rose steadily higher than in the symptomatic group. A progressive increase of incidental tumors from 13.0% in 1982 to 1983 to 59.2% in 1996 to 1997 was observed. A lower stage (74.3% versus 49.1%), grade (75.5% versus 56.9%), and percentage of metastases at presentation (10.4% versus 19.6%) were registered in the incidentally found neoplasms than in the symptomatic neoplasms. Eighty-two (80.4%) of 102 patients who underwent conservative surgery had incidental renal cell carcinoma.

Conclusions. Our data confirm a rapid and dramatic change in the epidemiologic and clinical characteristics of renal cancer, with an increasing number of incidentally found tumors presenting with lower stage, grade, and percentage of metastases. An unexpected but significantly higher rate of renal neoplasms was observed in older patients. The stage, grade, and patient age observed in our series of incidentally found tumors raises the question of whether to leave the current diagnostic approach unaltered, thus benefiting a subgroup of patients with clinically unrecognized and possibly indolent renal cell carcinoma, or to extend early detection programs to younger patients with potentially more aggressive tumors.

Section snippets

Patient characteristics

The medical records of 1092 consecutive patients with renal cancer observed from January 1, 1982 to December 31, 1997 were reviewed. All patients were admitted as a first referral. The age, sex, presenting symptoms, radiologic findings, pathologic stage and grade of the tumor, and type of treatment were analyzed. Tumors were staged according to the TNM staging system.8 Only those graded according to the Fuhrman grading system were considered.9 The clinical presentation of the neoplasms was

Results

The overall biennial incidence of renal tumors has steadily increased from 77 cases in 1982 to 1983 to 152 in 1996 to 1997. A peak incidence between the age of 60 and 70 years and an overall male/female ratio of 2:1 were noted. The distribution of 500 patients with incidental cancer (45.8%) of 1092 patients revealed an increase from 10 (13%) of 77 in 1982 to 1983 to 90 (59.2%) of 152 in 1996 to 1997 (Fig. 1).

The overall mean age at presentation increased from 57 years in 1982 to 1983 to 62.6

Comment

Reported series explicitly devoted to incidental renal masses (45 from 1982 to 1998) ranged from 53 to 783 patients in a multicenter analysis,11, 12, 14, 15, 16, 17, 18 with the exception of the series by Aso and Homma19 of 1428 patients, which was based on an investigation among 116 institutions. As observed in previous reports,5, 19 the overall incidence rate of renal tumors steadily increased in our series from 1982 to 1997. In particular, an increasing number of incidentally found RCCs was

Acknowledgements

To Gaetano Mobilio, Institute of Urology, University of Verona, for his advice and the supervision of the research project; Lucio Luciani, Department of Urology, Santa Chiara Hospital, Trento, for his continuing assistance and editing of the paper; and Aldo Valentini, Health Physics Unit, Santa Chiara Hospital, Trento, for his help in the statistical analysis.

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Adult urologyIncidental renal cell carcinoma—age and stage characterization and clinical implications: study of 1092 patients (1982–1997)

Abstract

Section snippets

Patient characteristics

Results

Comment

Acknowledgements

Clin Geriatr Med

J Urol

Urology

J Urol

J Urol

Urology

J Urol

J Urol

J Urol

J Urol

Rising incidence of renal cell cancer in the United States

JAMA

Cell proliferation in renal cell carcinoma

Scand J Urol Nephrol

Cancer statistics

CA Cancer J Clin

Cancer Statistics, 1999

CA Cancer J Clin

Increase of renal cell carcinoma incidence in central Europe

Eur Urol

Adult urology
Incidental renal cell carcinoma—age and stage characterization and clinical implications: study of 1092 patients (1982–1997)