title: Paraneoplastic signs and symptoms of renal cell carcinoma: implications for prognosis.
abstract: OBJECTIVE
  Renal cell carcinoma (RCC) can present with a wide range of signs and symptoms. To our knowledge we report the first study to describe the frequency of paraneoplastic findings in a modern RCC series and assess the prognostic significance of each finding.
  
  
  METHODS
  Using the kidney cancer database at our institution 1,046 patients undergoing nephrectomy for RCC between 1989 and 2001 were assessed. The prognostic significance of symptoms present at diagnosis and findings on preoperative laboratory evaluation were examined in a univariate analysis as well as on multivariate analysis controlling for TNM stage, Fuhrman grade and Eastern Cooperative Oncology Group performance status (ECOG-PS).
  
  
  RESULTS
  Mean followup to date of death or last contact for all patients was 40.3 months. Median time to death was 19.3 months. Most paraneoplastic signs and symptoms correlated with poor survival, although on multivariate analysis hypoalbuminemia, weight loss, anorexia and malaise predicted shorter survival. The frequency of each of these findings was 19.9%, 22.9%, 10.6% and 19.1%, respectively. Cachexia, defined as the presence of at least 1 of these findings, was noted in 35.3% of patients. Cachexia did not predict a higher recurrence rate in patients with localized disease and only malaise correlated with a decreased likelihood of responding to immunotherapy.
  
  
  CONCLUSIONS
  Cachexia, defined as hypoalbuminemia, weight loss, anorexia or malaise, predicts worse survival after controlling for well established indicators of prognosis (TNM stage, Fuhrman grade and ECOG-PS). Consideration should be given to expanding the ECOG-PS to include measures for cachexia when applied to patients with RCC.
authors.affiliation: Department of Urology, School of Medicine, University of California-Los Angeles, 10833 LeConte Avenue, Los Angeles, CA 90095, USA.
authors.forename: Hyung L
authors.initials: HL
authors.lastname: Kim
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
authors.forename: Danielo G
authors.initials: DG
authors.lastname: Freitas
authors.forename: Matthew H T
authors.initials: MH
authors.lastname: Bui
authors.forename: Ken-ryu
authors.initials: KR
authors.lastname: Han
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Dorey
authors.forename: Robert A
authors.initials: RA
authors.lastname: Figlin
mesh_terms: D000704:Analysis of Variance; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D015996:Survival Rate