Patient age remains a controversial factor in predicting prognosis for patients with renal cell carcinoma.
In this large population study led by Verhoest and colleagues from several European hospitals, the clinical parameters for four patient age groups were evaluated to determine the influence of age at diagnosis on tumor characteristics and outcomes for RCC.
In this study, the authors evaluated 4774 patients diagnosed with RCC and placed them into four age groups, 40 (6%), 40 and 60 (38.5%), 60 and 80 (52.3%), and 80 (3.2%). Clinicopathologic data for the entire population included gender, TNM stage, Fuhrman grade, tumor size, histologic subtype, and 5- and 10-year cancer-specific and overall survival rates. The median age of RCC diagnosis for the entire population was 62 years, while the median tumor size was 6 cm, and 66.7% of the patients were male.
Age inversely correlated with tumor size (p: 0.02), tumor stage (p < 0.001), Fuhrman grade (p < 0.001), ECOG PS (p < 0.001), M-stage (p: 0.02), presence of symptoms at diagnosis (p < 0.001), histologic subtype (p: 0.02), and 5- and 10-year cancer-specific and overall survival rates (p < 0.001 for both). Histologic subtype differences were especially pronounced in the 40 age group where the incidence of clear cell histology was significantly less than the others groups. Conversely, nodal status was not found to be statistically different among the age groups (p: 0.15).
The authors conclude that age is indeed an independent prognostic variable for RCC clinical parameters and overall survival. Younger patients appear to have lower stage and grade tumors, and a higher incidence of more favorable histologic subtypes such as papillary and chromophobe. Age at diagnosis should be considered in counseling patients regarding outcomes, but this factor should await further prospective validation prior to widespread implementation in prognostic nomograms.
Verhoest G, Veillard D, Guillé F, Taille ADL, Salomon L, Abbou CC, Valéri 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, Eggener SE
Eur Urol : 51(5) : 1298-1305
By Christopher G. Wood, MD