title: The effect of gender and age on kidney cancer survival: younger age is an independent prognostic factor in women with renal cell carcinoma.
abstract: OBJECTIVE
  Gender-specific differences in incidence of renal cell carcinoma (RCC) and its outcome have previously been reported. We used age as a surrogate to test whether this might be hormone-related in a large international RCC cohort.
  
  
  METHODS
  This study included patients treated by nephrectomy at 10 international academic centers. Clinicopathologic features were assessed using chi-square and the Student t-tests. Kaplan-Meier survival estimates and Cox proportional hazards models addressed the effect of gender and age on disease-specific survival.
  
  
  RESULTS
  Of the 5,654 patients, 3,777 (67%) were men and 1,877 (33%) were women. Generally, women presented at lower T stages (P<0.001), had fewer metastases (P<0.001), and had lower-grade tumors (P<0.001). Women more frequently had clear-cell (87% vs. 82%) and less frequently had papillary RCC (7% vs. 12%) than men (P<0.001). Women had a 19% reduced risk of death from RCC than men (hazard ratio 0.81, 95% confidence interval 0.73-0.90, P<0.001). The survival advantage for women was present to the greatest degree in the age group<42 years (P = 0.0136) and in women aged 42 to 58 years (P<0.001), but was not apparent in patients aged 59 years and older (P = 0.248). Age was an independent predictor of disease-specific survival in women (hazard ratio 1.011, 95% confidence interval 1.004-1.019, P = 0.004), but not in men.
  
  
  CONCLUSIONS
  As a group, women present with less advanced tumors, leading to a 19% reduced risk of RCC-specific death compared with men. This survival difference is present only in patients aged<59 years. Because this gender-based survival difference is not related to pathologic features, the role of hormonal effects on the development and progression of RCC needs to be investigated.
authors: Institute of Urologic Oncology, David Geffen School of Medicine, UCLA, CA; Division of Hematology/Oncology, Duke University Medical Center, NC.
authors: Edward N
authors: EN
authors: Rampersaud
authors: Department of Urology, Medical University of Vienna, Austria.
authors: Tobias
authors: T
authors: Klatte
authors: Division of Hematology/Oncology, Duke University Medical Center, NC.
authors: Geoffrey
authors: G
authors: Bass
authors: Department of Urology, Bicêtre Hospital, Paris XI University, Kremlin Bicêtre, France.
authors: Jean-Jacques
authors: JJ
authors: Patard
authors: Department of Urology, Rennes University Hospital, Rennes, France.
authors: Karim
authors: K
authors: Bensaleh
authors: Department of Urology, University of Magdeburg, Germany.
authors: Malte
authors: M
authors: Böhm
authors: Department of Urology, University of Magdeburg, Germany.
authors: Ernst P
authors: EP
authors: Allhoff
authors: Department of Urology, S. Pio da Pietrelcina Hospital, Vasto, Italy.
authors: Luca
authors: L
authors: Cindolo
authors: Department of Urology, Henri Mondor University Hospital, Paris, France.
authors: Alexandre
authors: A
authors: De La Taille
authors: Department of Urology, European Georges Pompidou Hospital, Paris, France.
authors: Arnaud
authors: A
authors: Mejean
authors: Department of Urology, University of Toulouse, France.
authors: Michel
authors: M
authors: Soulie
authors: Department of Urology, University of Toulouse, France.
authors: Laurent
authors: L
authors: Bellec
authors: Department of Urology, University Hospital, Bordeaux, France.
authors: Jean
authors: J
authors: Christophe Bernhard
authors: Department of Urology, Rouen University Hospital, Rouen, France.
authors: Christian
authors: C
authors: Pfister
authors: Department of Urology, Lyon University, Lyon, France.
authors: Marc
authors: M
authors: Colombel
authors: Institute of Urologic Oncology, David Geffen School of Medicine, UCLA, CA.
authors: Arie S
authors: AS
authors: Belldegrun
authors: Institute of Urologic Oncology, David Geffen School of Medicine, UCLA, CA. Electronic address: apantuck@mednet.ucla.edu.
authors: Allan J
authors: AJ
authors: Pantuck
authors: Division of Hematology/Oncology, Duke University Medical Center, NC.
authors: Daniel
authors: D
authors: George
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000453:epidemiology* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Age groups; Epidemiology; Gender; Renal cell carcinoma; Sex hormones