Table 1 : 5 yr disease specific survival post nephrectomy for RCC (Patard et al, 2005).
While there are 5 subtypes of renal cell carcinoma, 75% of which are clear cell, statistically the majority of tumours can be classified as a single entity as outcomes after surgery are similar (Capitanio et al, 2009).
There is significant benefit in performing radical surgery in patients with locally advanced tumours (T3):
| Cancer-specific survival comparing T3 renal cancers treated with or without radical nephrectomy | ||
| Surgery | No surgery | |
| 1 yr | 88.9% | 44.8% |
| 2 yr | 88.1% | 30.6% |
| 5 yr | 68.6% | 14.5% |
| 10 yr | 57.5% | 10.6% |
Table 2 : Cancer-specific survival comparing T3 renal cancers treated with or without radical
nephrectomy (Zini et al, 2009).
During 2013-2017 in England more than 85% of people at stage 1 survived their cancer for 5 years or more after they were diagnosed, 75% at stage 3, and only 10% at stage 4. [2]
For stages 2 and 3, patients with a 5-year survival rate at the higher end of the scale tend to have lower grade, indolent tumours, and are fit and well. Some studies have shown 5-year survival rates as high as 40% for patients with stage 4 renal cancers that are low grade and localised.
Prognosis for patients with metastases at diagnosis is poor, with or without surgery. Biological therapies, such as immunotherapy and protein kinase inhibitors have a significant role to play in disease management and quality of life post-surgery. Systemic treatment of late-stage renal cancer is discussed in Module 4.
There are around 4,600 kidney cancer deaths in the UK every year (2016-2018). Kidney cancer is the 13th most common cause of cancer death in the UK, accounting for 3% of all cancer deaths (2018).[1]
Summary
- Surgery is the first line treatment for all localised and locally advanced tumours and plays a part in palliation of advanced disease.
- Nephrectomy may be radical or partial, dependent on tumour and patient characteristics, and may be performed using an open or laparoscopic approach.
- Morbidity and 30-day mortality are low, but potential for injury to other organs is significant.
- Careful post-operative care is crucial to recovery.
- Laparoscopic surgery has advantages over open surgery in relation to recovery time.
- Partial nephrectomy preserves healthy functioning renal tissue and reduces incidence of renal insufficiency post-surgery.
- Following surgery, the tumour is classified using the Fuhrman system.
- Post-operative follow-up is dependent on multiple factors.
References
https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/kidney-cancer#heading-One
https://www.cancerresearchuk.org/about-cancer/kidney-cancer/survival
Pattard J J et al (2005). Prognostic Value of Histologic Subtypes in Renal Cell Carcinoma: A Multicenter Experience Journal of Clinical Oncology, 23 (12), April 20, pp2763-2771.
Capitanio U et al (2009). A Critical Assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: A population based study. BJU International, 103 (11), pp1496-1500.
Zini L et al (2009). Radical versus Partial Nephrectomy: Effect on overall and noncancer mortality. Cancer, 115 (7), pp1465-1471.
Bratslavsky G, Linehan w.m (2010) Long term management of bilateral multifocal , recurrent renal carcinoma nature reviews urology (7) 267-275.
Statistics and outlook for kidney cancer, Cancer Research UK, April 2016. Accessed at http://www.cancerresearchuk.org/about-cancer/type/kidney-cancer/treatment/statistics-and-outlook-for-kidney-cancer Accessed April 2016)
Krebsr.K, Andreoni C, Ortiz. (2013). (2014) impact of radical and partial nephrectomy on renal function in patients with renal cancer, Urologia Internationalis. 92 (4) 449-454