title: Clinical symptoms related to renal cell carcinoma are independent prognostic factors for intraoperative complications and overall survival.
abstract: OBJECTIVE
  It is not yet elucidated whether the symptoms related to renal cell carcinoma have a strong effect on intraoperative complications or survival. We aimed to investigate this association in a cohort of renal cancer patients operated on between June 1997 and December 2004 at the Department of Urology, Semmelweis University School of Medicine.
  
  
  METHODS
  Among 363 consecutive patients with renal masses treated at our institution, only 200 (55.3%) were truly asymptomatic and completely incidental (group A). Among the 259 patients with incidentally detected tumors, 59 (16.1%) had symptoms that were probably related to the renal lesion according to a reviewed history (group B) and 104 patients (28.6%) presented for symptoms related to renal cell cancer (group C).
  
  
  RESULTS
  Patients in group B had a higher risk for weight loss (P < 0.0001) and flank pain (P = 0.063), lower risk for symptoms related to distant metastases, while their outcome was not significantly different from group C. The collapsed group (B + C) had an increased risk for metastasis (P = 0.002), higher stage (P = 0.001), and intraoperative complications (P = 0.046) compared to group A according to a logistic regression. The presence of symptoms was significantly related to the overall survival using the Kaplan-Meier method (P < 0.0001).
  
  
  CONCLUSIONS
  Weight loss and flank pain were frequently neglected as a possible symptom of renal cancer by the patients. An easily accessible parameter (the presence of symptoms) was independently related to intraoperative complications and survival in renal cancer patients.
authors.affiliation: Department of Urology, Semmelweis University, Budapest, Hungary. aszendroi@gmail.com
authors.forename: Attila
authors.initials: A
authors.lastname: Szendroi
authors.forename: Adám
authors.initials: A
authors.lastname: Tabák
authors.forename: Peter
authors.initials: P
authors.lastname: Riesz
authors.forename: Miklós
authors.initials: M
authors.lastname: Szucs
authors.forename: Peter
authors.initials: P
authors.lastname: Nyírády
authors.forename: Attila
authors.initials: A
authors.lastname: Majoros
authors.forename: Gabriel
authors.initials: G
authors.lastname: Haas
authors.forename: Imre
authors.initials: I
authors.lastname: Romics
mesh_terms: D015746:Abdominal Pain / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005334:Fever / Q000503:physiopathology; D006417:Hematuria / Q000503:physiopathology; D006801:Humans; D033162:Incidental Findings; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000401:mortality; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D015431:Weight Loss