title: Sporadic renal cell carcinoma in young adults: presentation, treatment, and outcome.
abstract: OBJECTIVE
  To present our institutional experience with young adult patients treated for sporadic renal cell cancer (RCC) during the past two decades. Sporadic RCC is rare in patients younger than 40 years old, accounting for only 3.4% of cases.
  
  
  METHODS
  A retrospective review of 101 patients with sporadic RCC between the ages of 20 and 40 years was performed. The mean age at diagnosis was 33.7 +/- 5.5 years. Tumors were discovered incidentally in 40 patients (40%) and were symptomatic in 61 (60%). Sixteen patients (16%) had distant metastasis at diagnosis. For unilateral disease, 58 underwent radical nephrectomy and 31 nephron-sparing surgery (NSS). For bilateral RCC, 2 patients underwent bilateral radical nephrectomy, 3 underwent bilateral NSS, and 7 underwent NSS on one side and a staged contralateral radical nephrectomy. The mean postoperative follow-up was 48 +/- 44 months.
  
  
  RESULTS
  The overall and cancer-specific 5-year survival rate was 61% and 67%, respectively. Tumor stage (P < 0.001) and grade (P < 0.001) had a significant impact on survival. Incidentally discovered tumors were less likely to develop metastases and had improved cancer-specific survival compared with symptomatic tumors (P = 0.001). The 5-year cancer-specific survival rate by pathologic stage was 88% for T1N0M0, 64% for T2N0M0, 61% for T3N0M0, and 0% for N+ and M+ (P < 0.001).
  
  
  CONCLUSIONS
  The results of our study show that RCC does not behave more aggressively in young adults younger than 40 years old than in older adults. The major determinants of patient survival are tumor stage and grade at presentation. Outcome is similar in select patients whether undergoing NSS or radical nephrectomy.
authors.affiliation: Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Hazem I
authors.initials: HI
authors.lastname: Abou El Fettouh
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cherullo
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Jack
authors.forename: Youssef
authors.initials: Y
authors.lastname: Al Maslamani
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Novick
mesh_terms: D000328:Adult; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery; D009392:Nephrectomy / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate