UROLOGICAL ONCOLOGY

Renal cell carcinoma in adults 40 years old or less: young age is an independent prognostic factor for cancer-specific survival
Taccoen X, Valeri A, Descotes JL, Morin V, Stindel E, Doucet L, Joulin V, Bocqueraz F, Coulange C, Rambeaud JJ, Fournier G, Mejean A; Oncology Committee of the Association Française d’Urologie
Service d’Urologie, Centre Hospitalier et Universitaire, 29609 Brest Cedex, France
Eur Urol. 2007; 51: 980-7

• Objectives: Renal cell carcinoma (RCC) is uncommon in young adults. Based on the few studies published to date, it is difficult to determine whether this tumour has a particular progression pattern. This retrospective, multicentre study analysed RCC in young patients, defined as </= 40 yr old, compared to RCC in older patients.
• Methods: Between 1988 and 2000, 1233 patients, 93 under 40 yr old and 1140 older (mean ages, 34.2 and 61.9 years, respectively) underwent surgery for RCC in four teaching hospitals. Clinical and biologic parameters at diagnosis were compared and subjected to univariate and multivariate analyses to study survival. Mean follow-up was 4.5 yr for young and 4.1 yr for older patients.
• Results: When comparing younger to older patients, respectively, they had a lower male-to-female ratio (1.2 vs. 2.5), lower stage (84.9% vs. 67.4% pT1-pT2N0M0; p = 0.001), and fewer clear-cell carcinomas (73.1% vs. 82%), but more papillary carcinomas (20.4% vs. 11.4%; p = 0.01) and better 5-yr cancer-specific survival rates (90.8% vs. 78.3%; p = 0.005). Independent prognostic factors for survival, in the order of decreasing impact, were tumor stage (p < 0.0001), Fuhrman nuclear grade (p < 0.0001), and age </= 40 yr at diagnosis (risk ratio 0.4, p < 0.047). Young patients tended to have a better 5-yr progression-free survival (80.5% vs. 70.7%; p = 0.05).
• Conclusions: RCC in young adults was more often localised at diagnosis and had a better prognosis than the disease in older subjects. Age under 40 yr old was an independent prognostic factor for survival.
  
  
• Editorial Comment
  This report focuses on a large database of roughly 1300 patients with renal cell carcinoma from several hospitals in France. 10% of these patients were less than 40 years old and were analyzed in comparison to the older ones. Interestingly, young patients had a better 5 year progression-free prognosis.
  One of the factors that differed between these groups was that younger patients had more symptomatic tumors (60,2% vs. 50,4%), which , however, was not due to a different tumor size (5.8 cm vs. 6 cm). Aggressive growth showed differences, as favourable pT1 and pT2 tumors were more often among younger patients (84.9% vs. 67.4%). The differences between the age groups is interesting and, to my opinion, might be due to a shift in immunologic control with age. This should be focused in further scientific approaches on renal cell cancer.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
E-mail: boehle@urologie-bad-schwartau.de