Skip to main content
SpringerLink
Log in

Thinking beyond surgery in the management of renal cell carcinoma: the risk to die from renal cell carcinoma and competing risks of death

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Introduction

The presentation of renal cell carcinoma (RCC) has changed where it is most commonly identified when asymptomatic and incidental. Contemporary patients with renal tumors are often older in age and may have significant concurrent medical comorbidity, where proceeding with routine surgical treatment may not be of benefit. Traditional clinical assessments have not considered the impact of comorbidity on oncologic outcome, and recent studies have demonstrated the relationship between comorbidity and patient survival. We review the existing data examining the significance of medical comorbidity on RCC management and outcomes.

Materials and methods

The existing literature on this topic is reviewed, and validated measures of comorbidity are described. The available studies examining the relationship between comorbidity and RCC are summarized.

Results and Discussion

The article reviews the growing body of literature supporting the importance of assessment of patient comorbidity, and we highlight novel prognostic instruments that can estimate the likelihood of several different patient outcomes following RCC treatment, and these nomograms can be accessed via a web-based portal (www.cancernomograms.com) to assist in patient education and clinical decision making.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr (1999) Rising incidence of renal cell cancer in the United States. JAMA 281(17):1628–1631

    Article  CAS  PubMed  Google Scholar 

  2. Kane CJ, Mallin K, Ritchey J, Cooperberg MR, Carroll PR (2008) Renal cell cancer stage migration: analysis of the national cancer data base. Cancer 113(1):78–83

    Article  PubMed  Google Scholar 

  3. Parsons JK, Schoenberg MS, Carter HB (2001) Incidental renal tumors: casting doubt on the efficacy of early intervention. Urology 57(6):1013–1015

    Article  CAS  PubMed  Google Scholar 

  4. Russo P, Jang TL, Pettus JA et al (2008) Survival rates after resection for localized kidney cancer: 1989 to 2004. Cancer 113(1):84–96

    Article  PubMed Central  PubMed  Google Scholar 

  5. Gill IS, Kavoussi LR, Lane BR et al (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178(1):41–46

    Article  PubMed  Google Scholar 

  6. 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(18):1331–1334

    Article  PubMed  Google Scholar 

  7. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK (2007) Five-year survival after surgical treatment for kidney cancer: a population-based competing risk analysis. Cancer 109(9):1763–1768

    Article  PubMed  Google Scholar 

  8. Uijen AA, van de Lisdonk EH (2008) Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract 14(Suppl 1):28–32

    Article  PubMed  Google Scholar 

  9. Partnership JR. Chronic conditions: making the case for ongoing care. http://www.partnershipforsolutions.org/DMS

  10. Kassouf W, Aprikian AG, Laplante M, Tanguay S (2004) Natural history of renal masses followed expectantly. J Urol 171(1):111–113 (discussion 113)

    Article  CAS  PubMed  Google Scholar 

  11. Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA (2004) The natural history of incidentally detected small renal masses. Cancer 100(4):738–745

    Article  PubMed  Google Scholar 

  12. Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG (2006) The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 175(2):425–431

    Article  PubMed  Google Scholar 

  13. Crispen PL, Viterbo R, Boorjian SA, Greenberg RE, Chen DY, Uzzo RG (2009) Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance. Cancer 115(13):2844–2852

    Article  PubMed Central  PubMed  Google Scholar 

  14. Smaldone MC, Kutikov A, Egleston BL et al (2012) Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer 118(4):997–1006

    Article  PubMed  Google Scholar 

  15. Smaldone MC, Uzzo RG (2011) Active surveillance: a potential strategy for select patients with small renal masses. Future Oncol 7(10):1133–1147

    Article  PubMed  Google Scholar 

  16. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  17. Rochon PA, Katz JN, Morrow LA et al (1996) Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability. A prospective comparison of three comorbidity indices. Med Care 34(11):1093–1101

    Article  CAS  PubMed  Google Scholar 

  18. D’Hoore W, Sicotte C, Tilquin C (1993) Risk adjustment in outcome assessment: the Charlson comorbidity index. Methods Inf Med 32(5):382–387

    PubMed  Google Scholar 

  19. Pompei P, Charlson ME, Douglas RG Jr (1988) Clinical assessments as predictors of one year survival after hospitalization: implications for prognostic stratification. J Clin Epidemiol 41(3):275–284

    Article  CAS  PubMed  Google Scholar 

  20. Sarfati D (2012) Review of methods used to measure comorbidity in cancer populations: no gold standard exists. J Clin Epidemiol 65(9):924–933

    Article  PubMed  Google Scholar 

  21. Lund L, Jacobsen J, Norgaard M et al (2006) The prognostic impact of comorbidities on renal cancer, 1995 to 2006: a Danish population based study. J Urol 182(1):35–40 (discussion 40)

    Article  Google Scholar 

  22. Santos Arrontes D, Fernandez Acenero MJ, Garcia Gonzalez JI, Martin Munoz M, Paniagua Andres P (2008) Survival analysis of clear cell renal carcinoma according to the Charlson comorbidity index. J Urol 179(3):857–861

    Article  PubMed  Google Scholar 

  23. Gettman MT, Boelter CW, Cheville JC, Zincke H, Bryant SC, Blute ML (2003) Charlson co-morbidity index as a predictor of outcome after surgery for renal cell carcinoma with renal vein, vena cava or right atrium extension. J Urol 169(4):1282–1286

    Article  PubMed  Google Scholar 

  24. Berger DA, Megwalu II, Vlahiotis A et al (2008) Impact of comorbidity on overall survival in patients surgically treated for renal cell carcinoma. Urology 72(2):359–363

    Article  PubMed Central  PubMed  Google Scholar 

  25. Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr (2004) Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 291(20):2441–2447

    Article  CAS  PubMed  Google Scholar 

  26. O’Connor KM, Davis N, Lennon GM, Quinlan DM, Mulvin DW (2009) Can we avoid surgery in elderly patients with renal masses by using the Charlson comorbidity index? BJU Int 103(11):1492–1495

    Article  PubMed  Google Scholar 

  27. Campbell SC, Novick AC, Belldegrun A et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182(4):1271–1279

    Article  PubMed  Google Scholar 

  28. Ljungberg B, Cowan NC, Hanbury DC et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406

    Article  PubMed  Google Scholar 

  29. Kutikov A, Egleston BL, Wong YN, Uzzo RG (2010) Evaluating overall survival and competing risks of death in patients with localized renal cell carcinoma using a comprehensive nomogram. J Clin Oncol 28(2):311–317

    Article  PubMed Central  PubMed  Google Scholar 

  30. Lughezzani G, Sun M, Budaus L, Thuret R, Perrotte P, Karakiewicz PI (2010) Population-based external validation of a competing-risks nomogram for patients with localized renal cell carcinoma. J Clin Oncol 28(18):e299–e300 (author reply e301)

    Article  PubMed  Google Scholar 

  31. Kutikov A, Egleston BL, Canter D, Smaldone MC, Wong YN, Uzzo RG (2012) Competing risks of death in patients with localized renal cell carcinoma: a comorbidity based model. J Urol 188(6):2077–2083

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Fox Chase Cancer Center-Temple Health, 333 Cottman Avenue, Philadelphia, PA, 19111, USA

    David Y. T. Chen, Robert G. Uzzo & Rosalia Viterbo

Authors
  1. David Y. T. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert G. Uzzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rosalia Viterbo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Y. T. Chen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chen, D.Y.T., Uzzo, R.G. & Viterbo, R. Thinking beyond surgery in the management of renal cell carcinoma: the risk to die from renal cell carcinoma and competing risks of death. World J Urol 32, 607–613 (2014). https://doi.org/10.1007/s00345-014-1285-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-014-1285-6

Keywords

Search

Navigation