title: Do young patients with renal cell carcinoma feature a distinct outcome after surgery? A comparative analysis of patient age based on the multinational CORONA database.
abstract: OBJECTIVE
  We analyzed the distinct clinicopathological features and prognosis of patients with renal cell carcinoma age 40 years or less compared to a reference group of patients 60 to 70 years old.
  
  
  METHODS
  Overall 2,572 patients retrieved from a multicenter international database comprised of 6,234 patients with surgically treated renal cell carcinoma were included in this retrospective study. Clinical and histopathological features of 297 patients 40 years old or younger (4.8%) were compared to those of 2,275 patients (36.5%) 60 to 70 years old, who served as the reference group. Median followup was 59 months. The impact of young age and further parameters on disease specific mortality and all cause mortality was evaluated by multivariate Cox proportional hazards regression analyses.
  
  
  RESULTS
  Young patients more frequently underwent nephron sparing surgery (27% vs 20%, p = 0.008) and regional lymph node dissection compared to older patients (38% vs 32%, p = 0.025). Organ confined tumor stage (81% vs 70%, p <0.001), smaller tumor diameter (4.5 vs 4.7 cm, p = 0.014) and chromophobe subtype (10% vs 4%, p <0.001) were significantly more frequent in young patients. On multivariate analysis older patients had a higher disease specific (HR 2.21, p <0.001) and all cause mortality (HR 3.05, p <0.001). The c indices for the Cox models were 0.87 and 0.78, respectively. However, integration of the variable age group did not significantly increase the predictive accuracy of the disease specific and all cause mortality models.
  
  
  CONCLUSIONS
  Young patients with renal cell carcinoma (40 years old or younger) have significantly different frequencies of clinical and histopathological features, and a significantly lower all cause and disease specific mortality compared to patients 60 to 70 years old.
authors: Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany.
authors: Atiqullah
authors: A
authors: Aziz
authors: Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany.
authors: Matthias
authors: M
authors: May
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Richard
authors: R
authors: Zigeuner
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Martin
authors: M
authors: Pichler
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Thomas
authors: T
authors: Chromecki
authors: Department of Urology, Pio Da Pietrelcina Hospital, Vasto, Italy.
authors: Luca
authors: L
authors: Cindolo
authors: Department of Urology, Pio Da Pietrelcina Hospital, Vasto, Italy.
authors: Luigi
authors: L
authors: Schips
authors: Division of Urology, European Institute of Oncology, Milan, Italy.
authors: Ottavio
authors: O
authors: De Cobelli
authors: Department of Urology, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors: Bernardo
authors: B
authors: Rocco
authors: Department of Urology, Faculty of Health Sciences, University "La Sapienza", Ospedale Sant'Andrea, Rome, Italy.
authors: Cosimo
authors: C
authors: De Nunzio
authors: Department of Urology, Faculty of Health Sciences, University "La Sapienza", Ospedale Sant'Andrea, Rome, Italy.
authors: Andrea
authors: A
authors: Tubaro
authors: Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Romania.
authors: Ioan
authors: I
authors: Coman
authors: Department of Urology, Klinikum Dortmund, Dortmund, Germany.
authors: Michael
authors: M
authors: Truss
authors: Department of Urology, Klinikum Dortmund, Dortmund, Germany; Department of Urology, Medical University of Graz, Graz, Austria.
authors: Orietta
authors: O
authors: Dalpiaz
authors: Department of Urology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany.
authors: Bernd
authors: B
authors: Hoschke
authors: Department of Urology, St. Elisabeth Hospital Straubing, Straubing, Germany.
authors: Christian
authors: C
authors: Gilfrich
authors: Department of Urology, Emergency Hospital Satu Mare, Satu Mare, Romania.
authors: Bogdan
authors: B
authors: Feciche
authors: Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany.
authors: Fabian
authors: F
authors: Fenske
authors: Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors: Petros
authors: P
authors: Sountoulides
authors: Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors: Robert S
authors: RS
authors: Figenshau
authors: Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors: Kerry
authors: K
authors: Madison
authors: Department of Urology, Hospital Universitario Principe de Asturias, Alcala de Henares, Madrid, Spain.
authors: Manuel
authors: M
authors: Sánchez-Chapado
authors: Department of Urology, Hospital Universitario Principe de Asturias, Alcala de Henares, Madrid, Spain.
authors: Maria
authors: M
authors: Del Carmen Santiago Martin
authors: Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany.
authors: Wolf F
authors: WF
authors: Wieland
authors: Department of Urology, G. Rummo Hospital, Benevento, Italy.
authors: Luigi
authors: L
authors: Salzano
authors: Department of Urology, G. Rummo Hospital, Benevento, Italy.
authors: Giuseppe
authors: G
authors: Lotrecchiano
authors: Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Munich, Germany.
authors: Raphaela
authors: R
authors: Waidelich
authors: Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Munich, Germany.
authors: Christian
authors: C
authors: Stief
authors: Department of Urology, Ludwig-Maximilians-University Munich, Klinikum Großhadern, Munich, Germany. Electronic address: sabine.brookman-may@email.de.
authors: Sabine
authors: S
authors: Brookman-May
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models
keywords: LND; NSS; RCC; age factors; carcinoma; lymph node dissection; neoplasms by histologic type; nephrectomy; nephron sparing surgery; outcome assessment; renal cell; renal cell carcinoma