Cachexia-Like Symptoms Predict a Worse Prognosis in Localized T1 Renal Cell Carcinoma.

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 May 2004Cachexia-Like Symptoms Predict a Worse Prognosis in Localized T1 Renal Cell Carcinoma. HYUNG L. KIM, KEN-RYU HAN, AMNON ZISMAN, ROBERT A. FIGLIN, and ARIE S. BELLDEGRUN HYUNG L. KIMHYUNG L. KIM , KEN-RYU HANKEN-RYU HAN , AMNON ZISMANAMNON ZISMAN , ROBERT A. FIGLINROBERT A. FIGLIN , and ARIE S. BELLDEGRUNARIE S. BELLDEGRUN View All Author Informationhttps://doi.org/10.1097/01.ju.0000121440.82581.d3AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Although cachexia is a common sequela of advanced and metastatic renal cell carcinoma (RCC), cachexia-like symptoms may also represent a paraneoplastic finding. We assessed the prognostic significance of these symptoms in patients with stage T1 RCC. Materials and Methods: Using the kidney cancer database at our institution 250 patients were identified who underwent partial or radical nephrectomy for T1N0M0 RCC between 1989 and 2001. The prognostic significance of the symptoms present at diagnosis and findings on preoperative laboratory evaluation were examined. Results: Mean and median followup was 33 and 43 months, respectively. Malaise, weight loss, anorexia and hypoalbuminemia were cachexia related findings that were significant predictors of worse disease specific survival (DSS). DSS in patients with 1 vs greater than 1 cachexia related symptoms was not significantly different (p = 0.077). Therefore, any patient with at least 1 cachexia related finding was considered to be positive for cachexia and cachexia occurred in 37 (14.8%). Cachexia was associated with significantly worse recurrence-free survival (HR 3.03, p = 0.032) and DSS (HR 4.39, p = 0.011) even after controlling for tumor size, grade and performance status. The 5-year survival rate in patients with low grade (1 or 2) tumors with and without cachexia was 91% and 81%, respectively. The 5-year survival rate in patients with high grade (3 or 4) tumors with and without cachexia was 75% and 55%, respectively. Conclusions: Cachexia-like symptoms independently predict a worse prognosis in patients with T1 RCC. Patients with cachexia (malaise, weight loss, anorexia and hypoalbuminemia), especially when associated with high grade tumors, should be considered for clinical trials of adjuvant therapies. References 1 : Paraneoplastic signs and symptoms of renal cell carcinoma: implications for prognosis. J Urol2003; 170: 1742. Link, Google Scholar 2 : TNM staging of renal cell carcinoma: Workgroup No. 3. Union International Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer1997; 80: 992. Crossref, Medline, Google Scholar 3 : Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol1982; 5: 649. Google Scholar 4 : Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol1982; 6: 655. Crossref, Medline, Google Scholar 5 : Improved prognostication of renal cell carcinoma using an integrated staging system. J Clin Oncol2001; 19: 1649. Crossref, Medline, Google Scholar 6 : Renal cell carcinoma: prognostic significance of incidentally detected tumors. J Urol2000; 163: 426. Link, Google Scholar 7 : Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer2003; 97: 1663. Google Scholar 8 : Improvement in survival of patients with renal cell carcinoma—the role of the serendipitously detected tumor. J Urol1988; 140: 487. Link, Google Scholar 9 : Prognostic factors for survival in patients with metastatic renal cancer treated with biological response modifiers. J Urol1995; 154: 35. Link, Google Scholar 10 : Parathyroid hormonelike protein from human renal carcinoma cells. Structural and functional homology with parathyroid hormone. J Clin Invest1987; 80: 1803. Google Scholar 11 : A parathyroid hormone-related protein implicated in malignant hypercalcemia: cloning and expression. Science1987; 237: 893. Google Scholar 12 : Hormones in renal cancer. J Urol1977; 117: 433. Link, Google Scholar 13 : Renin-secreting clear cell carcinoma of the kidney. Arch Intern Med1975; 135: 859. Google Scholar 14 : Paraneoplastic syndromes associated with renal cell carcinoma. J S C Med Assoc1987; 83: 375. Google Scholar 15 : Paraneoplastic syndromes in hypernephroma. Semin Nephrol1987; 7: 123. Google Scholar 16 : Central nervous system mechanisms contributing to the cachexia-anorexia syndrome. Nutrition2000; 16: 1009. Google Scholar 17 : Role of cytokines in cancer cachexia in a murine model of intracerebral injection of human tumours. Cytokine2001; 15: 27. Google Scholar 18 : Biological evaluation of a lipid-mobilizing factor isolated from the urine of cancer patients. Cancer Res1998; 58: 2359. Google Scholar 19 : Lipolytic activity of anemia-inducing substance from tumor-bearing rabbits. Nutr Cancer1999; 33: 201. Google Scholar 20 : Characterization of a cancer cachectic factor. Nature1996; 379: 739. Google Scholar 21 : Increased incidence of serendipitously discovered renal cell carcinoma. Urology1998; 51: 203. Crossref, Medline, Google Scholar 22 : Renal cell carcinoma: incidental diagnosis and natural history: review of 235 cases. Urology1992; 39: 519. Crossref, Medline, Google Scholar From the Departments of Urology and Medicine (RAF), University of California School of Medicine, Los Angeles, California© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 171Issue 5May 2004Page: 1810-1813 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordscachexiacarcinoma, renal cellprognosiskidneyMetricsAuthor Information HYUNG L. KIM More articles by this author KEN-RYU HAN More articles by this author AMNON ZISMAN More articles by this author ROBERT A. FIGLIN More articles by this author ARIE S. BELLDEGRUN More articles by this author Expand All Advertisement PDF downloadLoading ...