title: The changing natural history of renal cell carcinoma.
abstract: OBJECTIVE
  Our understanding of the natural history of renal cell carcinoma, the role of nephrectomy, the benefits of immunotherapy and the possibilities of new technologies are evolving and being integrated with advances in classification and staging. We reviewed the relevant literature to clarify these pertinent questions and provide a current review of the changes in the epidemiology, treatment and prognosis of patients with renal cell carcinoma.
  
  
  METHODS
  We comprehensively reviewed the peer reviewed literature on the current management of and results of treatment for renal cell carcinoma.
  
  
  RESULTS
  The incidence of and mortality from renal cell carcinoma have continuously increased during the last 50 years. Despite this increase in the number of new patients and consequently the number of deaths yearly the percent of those surviving for 5 years has notably improved. Factors related to improved survival include advances in renal imaging, earlier diagnosis, improved staging, better understanding of prognostic indicators, refinement in surgical technique and the introduction of immunotherapy approaches for advanced disease.
  
  
  CONCLUSIONS
  Currently patients with localized and metastatic renal cell carcinoma have had improvements in outlook and the therapeutic options available have expanded.
authors.affiliation: Department of Urology, University of California School of Medicine, Los Angeles, California, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Pantuck
authors.forename: A
authors.initials: A
authors.lastname: Zisman
authors.forename: A S
authors.initials: AS
authors.lastname: Belldegrun
mesh_terms: D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D018450:Disease Progression; D006801:Humans; D007167:Immunotherapy; D015994:Incidence; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009392:Nephrectomy; D011379:Prognosis; D016019:Survival Analysis