title: Renal cell carcinoma in adults 40 years old or less: young age is an independent prognostic factor for cancer-specific survival.
abstract: 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.
authors.affiliation: Service d'Urologie, Centre Hospitalier et Universitaire, 29609 Brest Cedex, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Taccoen
authors.forename: Antoine
authors.initials: A
authors.lastname: Valeri
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Descotes
authors.forename: Vincent
authors.initials: V
authors.lastname: Morin
authors.forename: Eric
authors.initials: E
authors.lastname: Stindel
authors.forename: Laurent
authors.initials: L
authors.lastname: Doucet
authors.forename: Vincent
authors.initials: V
authors.lastname: Joulin
authors.forename: Frederic
authors.initials: F
authors.lastname: Bocqueraz
authors.forename: Christian
authors.initials: C
authors.lastname: Coulange
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Rambeaud
authors.forename: Georges
authors.initials: G
authors.lastname: Fournier
authors.forename: Arnaud
authors.initials: A
authors.lastname: Mejean
mesh_terms: 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