A Prospective Observational Study on Effectiveness of Prognostic Factors Influencing Disease Free Survival in Renal Cell Carcinoma

Abstract

AIMS AND OBJECTIVES:To study the effectiveness of prognostic factors influencing the disease free survival in non-metastatic renal cell carcinoma. To access how well the available study designs such as UNIVERSITY OF CALIFORNIA AND LOS ANGELS and SSIGN could be used to access the prognosis of renal carcinoma on hand. INCLUSION CRITERIA: All the patients undergoing radical nephrectomy for renal cell carcinoma above 18 years of age are included in the study. EXCLUSION CRITERIA: All the patients with renal cell carcinoma under the age of 18 are excluded. All the metastatic renal cell carcinoma patients were excluded. All the patients with bilateral renal cell carcinoma are excluded. MATERIALS AND METHODS: A prospective case series study was conducted after getting approval from thesis committee in the Department of Urology, and followed up in the Department of Urology; Gandhi medical College, Secundrabad, for a period of 12 months from June 2012 to May 2013. RESULTS: A total of 30 patients with non-metastatic renal cell carcinoma who underwent radical nephrectomy were followed up for one year. At the end of one year follow up 24 patients (80%) had one year disease free survival. Previous studies to compare prognostic factors of renal cell carcinoma for disease free survival at 1 year are limited and hence the results are compared to studies of five years of follow up. CONCLUSION: Our follow-up guidelines after nephrectomy for non-metastatic RCC, based on an integrated stage-specific, and tumor size protocol, stratifying patients in to risk groups showed to be useful to predict recurrence and survival in patients with non-metastatic RCC. Among the clinical related prognostic factors age, mode of presentation had no independent prognostic information at one year of follow up but performance status proved to be a significant prognostic factor. Among tumor related prognostic factors, RCC subtypes and nuclear grade had no independent prognostic value but tumor size, nodal positivity, presence of necrosis and staging had independent prognostic value. Among serum markers, ESR has no prognostic value. The available prognostic models like UCLA and SSIGN designs proved to be useful models for accessing prognosis of non-metastatic renal cell carcinoma at one year of follow up.