The object of this study was to investigate the long-term prognosis and prognostic factors, symptoms and change in diagnostics among renal cell carcinoma (RCC) patients diagnosed in the Pirkanmaa region. To this end, we collected information from the original medical records of 970 RCC patients diagnosed between 1963 and 1997. Follow-up was up to August 2007, the longest follow-up being 35 years. RCC is a rare disease. During 2011, according to the most recent statistics in the Finnish Cancer Registry, new cases of kidney cancer were diagnosed in 415 females and 562 males nationwide. Of these, 42 females and 43 males were diagnosed in the Pirkanmaa Hospital District. Almost 40 years has passed since the last publication on the clinical presentation of RCC in Finland. Apart from this, we found no data on the current symptoms of RCC in the international literature. This lack of information prompted us to collect the present material. RCC involves poor long-term survival. Here primarily metastatic disease was found in 26% of patients and 30% relapsed during follow-up, some of these even after a 20-year disease-free period.
After 25 years only 26% of patients were alive. Fifty per cent of operated women and 43% of operated men remained disease-free; 47% of all women and 54% of all men died of RCC. Stage, age and symptomatic disease were the most important clinical prognostic factors. Also grade, gender, smoking status and body mass index (BMI) were significant. In terms of the order of importance of clinical factors, the clinical presentation proved a stronger prognostic factor than BMI. Obese patients had better survival (5.9 years) than normal or underweight patients (3.4 years and 12 months, respectively) with lower-stage, asymptomatic tumors. Smokers had poorer survival in localized tumors than non-smokers; in stage I tumors five-year overall survival was 71% vs. 89%, respectively. In cancer-spesific survival there was no difference between smoking status groups, even though smokers had more relapses and a shorter disease-free interval. There was no difference in patient-dependent delay. We found no other explanatory factors for recurrent disease than the smoking itself.
RCC tumors are nowadays more often small and of lower stage than those diagnosed before computed tomography (CT) and ultrasound came into general use. However, in this study only 12% of tumors were <3.0 cm in diameter; most being found in recent study years. These tumors were more often asymptomatic and had better prognosis than larger tumors. The survival rate after 20 years was 67% vs. 30% in patients with small or large tumors, respectively. More imaging studies were needed to assess these small tumors, but the diagnostic accuracy was the same as with larger growths. The mean figure was 3.17 in the group with small tumors and 2.92 in large tumors. CT proved the best method.
The most common symptoms of RCC were flank pain, hematuria and high erythrocyte sedimentation rate (ESR). During the study period, the incidence of hematuria (from 39% to 26%) and high ESR (from 28% to 20%) decreased, but there was no change in other symptoms.
In conclusion, long-term survival in RCC was still poor regardless of the development of diagnostics and treatment; it was the cause of death in 47% of women and 54% of men. The previously known clinical prognostic factors, for example stage, age and clinical presentation, were valid also in Finnish patients. Of prognostic factors, symptomatic disease was stronger than high BMI, which normally signifies better prognosis. Symptoms of RCC changed only little during the study period; only the incidence of hematuria and high ESR decreased. The use of diagnostic imaging studies has changed substantially since CT and ultrasound became available. The use of angiography, cavography and urography has decreased along with this change.