title: Impact of tumor-associated symptoms on the prognosis of patients with renal cell carcinoma: a single-center experience of 683 patients.
abstract: OBJECTIVE
  To evaluate the impact of cancer-associated symptoms present at the diagnosis of renal cell carcinoma (RCC) on the prognosis of patients. Increasing numbers of RCC are currently detected incidentally by routine ultrasonography.
  
  
  METHODS
  From January 1994 to December 2000, 693 operations for RCC in 683 consecutive patients have been performed at our institution. Overall, tumor-specific, and progression-free survival were investigated using the Kaplan-Meier method. For multivariate analysis regarding tumor-specific survival, the Cox regression model, including risk ratios, was used. A receiver operating characteristics curve regarding the sensitivity and specificity for the association between tumor size and symptoms was used.
  
  
  RESULTS
  Of the 683 patients, 417 patients were male and 266 female. The mean patient age was 62 years (range 16 to 88). Of the 683 patients, 141 (20.8%) presented with symptoms suspicious for cancer. The 5-year overall, progression-free, and cancer-specific survival rates were 82%, 79%, and 86%, respectively, for asymptomatic patients compared with 60%, 55%, and 65%, respectively, for patients with symptoms at diagnosis (P <0.0001, log-rank test). The cutoff value of 5 cm for the tumor diameter to result in symptoms was chosen on the receiver operating characteristic curve. Multivariate analysis found tumor grade (P = 0.001), tumor stage (P = 0.001), presence of symptoms (P = 0.013), and tumor diameter (P = 0.005) to be independent prognostic parameters for cancer-specific survival.
  
  
  CONCLUSIONS
  Tumors larger than 5 cm were significantly more likely to cause symptoms compared with smaller tumors in our series. In multivariate analysis, patients presenting with symptoms suspicious for cancer at the diagnosis of RCC had a 1.8-fold greater risk of dying of cancer compared with patients without symptoms.
authors.affiliation: Department of Urology, Karl Franzens University Graz, Graz, Austria.
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.forename: Katja
authors.initials: K
authors.lastname: Lipsky
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Michael
authors.initials: M
authors.lastname: Salfellner
authors.forename: Susanne
authors.initials: S
authors.lastname: Winkler
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
authors.forename: Peter
authors.initials: P
authors.lastname: Rehak
authors.forename: Karl
authors.initials: K
authors.lastname: Pummer
authors.forename: Gerhart
authors.initials: G
authors.lastname: Hubmer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000401:mortality* / Q000556:secondary; D018572:Disease-Free Survival; D005221:Fatigue / Q000209:etiology; D005260:Female; D021501:Flank Pain / Q000209:etiology; D005598:Fractures, Spontaneous / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D006801:Humans; D033162:Incidental Findings; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D015996:Survival Rate; D015431:Weight Loss