title: Clinical features and prognosis of patients with renal cancer and a second malignancy.
abstract: OBJECTIVE
  To evaluate the epidemiologic aspects, the clinical features, and the prognosis of patients with renal cancer affected by a second malignancy.
  
  
  METHODS
  Since 1983, at our institution, a database concerning all the patients who underwent surgery for renal neoplasia has been prospectively compiled. In the present study, we compared patients with renal cancer and a second primary malignancy, diagnosed before, at the same time, or after the renal cancer, to those affected only by a renal malignancy.
  
  
  RESULTS
  Out of 1,673 patients with renal cancer, 285 (17%) were diagnosed with a second malignancy. The follow-up lasted on average 71 months after the treatment of renal neoplasia. The second neoplasia was antecedent in 115 patients (average latency period 8.5 years), synchronous in 97 patients, and subsequent in 103 patients (average latency period 4.4 years). The sites of associated neoplasia were, in descending order of frequency, prostate, bladder, and bowel for men and breast, gynecologic organs, thyroid, and bladder for women. Compared with the patients not affected by a second neoplasm, those with multiple malignancies generally were older and had a smaller, low-grade, low-stage, and asymptomatic renal tumor. Comparing patients with associated neoplasia with a group without associated neoplasia matched for gender, mode of diagnosis, dimension, grade, stage, and histologic subtype of renal cancer, at survival analysis, no significant differences were noticed in renal cancer-related survival. However, among patients with multiple malignancies, the contemporaneous diagnosis of renal and associated cancer had an independent negative impact on survival.
  
  
  CONCLUSIONS
  The association between renal cancer and other malignancies is a frequent event with an unremarkable impact on prognosis, and it shall not limit surgical indication to treat renal cancer, even if the negative prognostic impact of synchronous occurrence of multiple neoplasias should be regarded, especially in older or unhealthy patients, since ablative therapies or active surveillance could be considered as viable alternative options.
authors.affiliation: Departments of Urology, Biomedical Sciences, and Biotechnology University of Brescia, Brescia, Italy. alxanto@hotmail.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Calza
authors.forename: Nicola
authors.initials: N
authors.lastname: Arrighi
authors.forename: Danilo
authors.initials: D
authors.lastname: Zani
authors.forename: Serena
authors.initials: S
authors.lastname: Corti
authors.forename: Alberto
authors.initials: A
authors.lastname: Cozzoli
authors.forename: Tiziano
authors.initials: T
authors.lastname: Zanotelli
authors.forename: Sergio Cosciani
authors.initials: SC
authors.lastname: Cunico
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary / Q000150:complications* / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D014018:Tissue Distribution