title: Renal cell carcinoma in children, adolescents and young adults: a National Cancer Database study.
abstract: OBJECTIVE
  We compared the presentation and outcomes of patients younger than 21 years with renal cell carcinoma and determined risk factors associated with mortality.
  
  
  METHODS
  We searched the National Cancer Database for patients diagnosed with renal cell carcinoma between 1998 and 2011. We evaluated patients younger than 30 years with renal cell carcinoma, including clear cell, chromophobe, papillary and not otherwise specified subcategories. We used logistic regression to compare presenting cancer, demographics and treatment variables in patients 0 to 15 years, 15 to 21 years and 21 to 30 years old. Cox regression analysis was used to determine risk factors for mortality in patients younger than 21.
  
  
  RESULTS
  Of 3,658 patients younger than 30 years included in the study 161 were younger than 15 and 337 were 15 to 21 years old. A higher proportion of younger patients had renal cell carcinoma not otherwise specified and papillary histology compared to those 21 to 30 years (p < 0.001). Younger patients presented with higher stage (p < 0.0001), higher grade (p < 0.0001) and larger tumors (p < 0.0001) than those 21 to 30 years. A higher percentage of younger patients underwent lymph node dissection (p < 0.0001) or chemotherapy as first-line treatment (p < 0.0001) compared to those 21 to 30 years. Cox regression analysis demonstrated that stage 4 presentation, government insurance status, nonchromophobic pathology results and not undergoing surgery as first-line treatment were independently associated with increased mortality in patients younger than 21 years.
  
  
  CONCLUSIONS
  Children and adolescents with renal cell carcinoma present with more advanced disease than those 21 to 30 years old. In patients younger than 21 years mortality was associated with the nonchromophobe histological subtype, stage 4 disease, government insurance and not undergoing surgery as first-line therapy.
authors.affiliation: Department of Urology, Division of Pediatric Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Ardavan
authors.initials: A
authors.lastname: Akhavan
authors.affiliation: Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Morgan
authors.initials: M
authors.lastname: Richards
authors.affiliation: Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Margarett
authors.initials: M
authors.lastname: Shnorhavorian
authors.affiliation: Department of Surgery, University of Washington, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Adam
authors.initials: A
authors.lastname: Goldin
authors.affiliation: Division of General and Thoracic Surgery, University of Washington, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Gow
authors.affiliation: Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Merguerian
mesh_terms: D000293:Adolescent; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D002648:Child; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D055815:Young Adult
keywords: carcinoma; kidney neoplasms; pediatrics; renal cell