title: Correlation between symptom graduation, tumor characteristics and survival in renal cell carcinoma.
abstract: OBJECTIVE
  To compare renal tumors with respect to initial clinical presentation and assess the prognostic value of a symptom based classification.
  
  
  METHODS
  Based on symptoms at diagnosis, 388 renal tumors were stratified into three groups: (1) asymptomatic tumors; (2) tumors with local symptoms (3) tumors with systemic symptoms. The three groups were compared for usual clinical and pathological variables using chi(2)-tests and Anova regression, for qualitative and quantitative variables, respectively. Survival assessment was made with univariate and multivariate analysis using the Kaplan-Meier method and Cox regression analysis.
  
  
  RESULTS
  The three defined groups were significantly different for all analysed variables except for age, sex ratio and pathological subtype. In univariate analysis: ECOG performance status, symptom classification, tumour size, TNM stage and grade, adrenal, perinephric fat or vein invasion were significant prognostic factors (p<0.001). In multivariate analysis, symptom classification, TNM stage, Fuhrman grade and perinephric fat invasion remained independent prognostic factors (p<0.001).
  
  
  CONCLUSIONS
  The proposed classification merits further validation through multi-institutional studies before integrating it in further prognosis algorithms.
authors.affiliation: Service d'Urologie, CHU Pontchaillou, rue Henri Le Guilloux, 35033 Rennes, France. jean-jacques.patard@chu-rennes.fr
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Leray
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.forename: François
authors.initials: F
authors.lastname: Guillé
authors.forename: Bernard
authors.initials: B
authors.lastname: Lobel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000145:classification* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007680:Kidney Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis