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Abstract
Purpose
This study compared the clinicopathological features, diagnosis and prognosis of an incidental renal cell carcinoma with those of a symptomatic carcinoma.
Materials and Methods
The medical records of 140 renal cell carcinoma patients at our hospital between 1995 and 2004 were reviewed. The patients were divided into two groups: asymptomatic and symptomatic patients. The patients’ characteristics, radiologic studies, tumor stage, tumor size, nuclear grade, and survival rates were investigated. The data was analyzed using a chi-square test, Student’s t-test and Kaplan-Meier survival curve.
Results
Of the 140 patients 57 (41%) were asymptomatic and 83 (59%) were symptomatic. The median tumor size was 5.2cm for incidental cancer and 8.1cm for symptomatic cancer. The 5-year cancer specific survival rate was significantly higher for the incidental tumors than the symptomatic tumors (78.9% versus 45.8%). When adjusted for stage, there was no difference in survival in those with stage I to IV disease between the 2 groups. Stage I, II lesions were present in 82.5% of patients in the incidental group and 39.7% in the symptomatic group. In contrast, a stage Ⅲ, Ⅳ lesion was present in 17.5% of the patients in the incidental group compared with 60.3% in the symptomatic group. A higher tumor grade of symptomatic lesions was also noted.
Conclusions
The incidental group showed a significantly lower stage and grade, and a higher 5-year survival rate. This result was attributed to the early detection of renal cell carcinoma before the onset of symptoms. Overall, early detection of renal cell carcinoma using radiologic tools will improve the prognosis of renal cell carcinoma.
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Fig. 1.
Overall Kaplan-Meier cancer-specific survival (months) in the patients with an incidental (full-line) and symptomatic (dot-line) renal cell carcinoma (log rank p=0.0001).
Fig. 2.
Kaplan-Meier cancer-specific survival (months) in the patients with a stage I incidental (full-line) and symptomatic (dot-line) renal cell carcinoma (log rank p=0.5899).
Fig. 3.
Kaplan-Meier cancer-specific survival (months) in the patients with a stage II III incidental (full-line) and symptomatic (dot-line) renal cell carcinoma (log rank p=0.3131).
Fig. 4.
Kaplan-Meier cancer-specific survival (months) in the patients with a stage IV incidental (full-line) and symptomatic (dot-line) renal cell carcinoma (log rank p=0.4572).
Table 1.
Characteristics of the patients with an incidental or symptomatic renal cell carcinoma
Table 2.
Radiology study used to detect the renal cell carcinoma n the asymptomatic patients, n (%)
| Year | IVP | US | CT | MRI | Total |
|---|---|---|---|---|---|
| 1995-1999 | 0 | 17 (81) | 4 (19) | 0 | 21 (30) |
| 2000-2004 | 1 (3) | 25 (72) | 8 (22) | 1 (3) | 36 (51) |
Table 3.
Stage of the incidental and symptomatic renal cell carcinoma, n (%)
Table 4.
Fuhrman’s nuclear grade in the patients with an incidental and symptomatic renal cell carcinoma (%)
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