How do symptoms have an impact on the prognosis of renal cell carcinoma?

Aim: Symptomatic renal cell carcinoma (RCC) is well known to have a characteristic behavior. We therefore evaluated the impact of systemic symptoms on the prognosis of RCC. Methods: Patard's criteria were used to classify symptoms before operation into three groups defined as: S1 (incidental tumor), S2 (localized symptoms) and S3 (systemic symptoms). Selected clinicopathological factors including gender, maximum tumor diameter, clinical stage, hemoglobin, C-reactive protein (CRP) and immunosuppressive acidic protein, nuclear grade and venous invasion were measured preoperatively in 252 patients. To determine impacts of them on the prognosis of RCC, we compared quantitative results using Cox multivariate analysis. Results: The cancer-specific five-year survival rates were 93.1%, 71.0%, and 20.2% for S1 (144 patients), S2 (80 patients) and S3 (28 patients), respectively (P < 0.0001). By the univariate analysis, S2 and S3 were significant prognostic factors (risk ratio 4.5, P = 0.0003, risk ratio 19.15, P < 0.0001, respectively). By the multivariate analysis limited to preoperative clinical characteristics, S3 and CRP were independent factors (risk ratio 7.05, P = 0.0006, risk ratio 3.53, P = 0.0052, respectively). When pathological factors as well as preoperative clinical features were included on multivariate analysis, S3 and CRP remained to be independent predictive factors (risk ratio 6.01, P = 0.0031, risk ratio 2.64, P = 0.0040, respectively). Among pathological factors, only nuclear grade was a significant prognostic factor (risk ratio 2.92, P = 0.013). Conclusion: The presence of systemic symptoms is an independent prognostic factor along with nuclear grade and CRP.