Renal cell carcinoma in adults 40 years old or less: young age is an independent prognostic factor for cancer-specific survival.
OBJECTIVE
Renal cell carcinoma (RCC) is uncommon in young adults. Based on the few studies published to date, it is difficult to determine whether this tumour has a particular progression pattern. This retrospective, multicentre study analysed RCC in young patients, defined as </=40 yr old, compared to RCC in older patients.


METHODS
Between 1988 and 2000, 1233 patients, 93 under 40 yr old and 1140 older (mean ages, 34.2 and 61.9 years, respectively) underwent surgery for RCC in four teaching hospitals. Clinical and biologic parameters at diagnosis were compared and subjected to univariate and multivariate analyses to study survival. Mean follow-up was 4.5 yr for young and 4.1 yr for older patients.


RESULTS
When comparing younger to older patients, respectively, they had a lower male-to-female ratio (1.2 vs. 2.5), lower stage (84.9% vs. 67.4% pT1-pT2N0M0; p=0.001), and fewer clear-cell carcinomas (73.1% vs. 82%), but more papillary carcinomas (20.4% vs. 11.4%; p=0.01) and better 5-yr cancer-specific survival rates (90.8% vs. 78.3%; p=0.005). Independent prognostic factors for survival, in the order of decreasing impact, were tumor stage (p<0.0001), Fuhrman nuclear grade (p<0.0001), and age </=40 yr at diagnosis (risk ratio 0.4, p<0.047). Young patients tended to have a better 5-yr progression-free survival (80.5% vs. 70.7%; p=0.05).


CONCLUSIONS
RCC in young adults was more often localised at diagnosis and had a better prognosis than the disease in older subjects. Age under 40 yr old was an independent prognostic factor for survival.
Taccoen
Xavier
X
Service d'Urologie, Centre Hospitalier et Universitaire, 29609 Brest Cedex, France.
Valeri
Antoine
A
Descotes
Jean-Luc
JL
Morin
Vincent
V
Stindel
Eric
E
Doucet
Laurent
L
Joulin
Vincent
V
Bocqueraz
Frederic
F
Coulange
Christian
C
Rambeaud
Jean-Jacques
JJ
Fournier
Georges
G
Mejean
Arnaud
A
D000328:Adult; D000367:Age Factors; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate