Outcome of renal tumors in young adults

Abstract

Purpose: Sporadic RCC is rare in young adults. We retrospectively reviewed the outcomes of patients 20 to 40 years old at our institution.

Materials and methods: Between 1975 and 2004, 2,710 patients were treated surgically for renal masses at our institution. We found 120 patients (4.4%) 20 to 40 years old. We analyzed the clinical presentation, pathological characteristics and outcome of these patients, and compared it to patients older than 40 years.

Results: The mean age of 120 young adults was 34.1 years (range 20.4 to 39.8). Symptomatic presentation was documented in 49.5% of patients. RCC was found in 87 (72.5%) young adults. Young patients generally had a higher rate of organ confined tumors than patients older than 40 years (73.6% vs 59.3%, p <0.05). Histopathological characteristics, tumor size, lymph node metastases and distant metastatic disease did not differ significantly in young and older patients. Women were significantly more likely to have benign lesions (41% vs 20%, p <0.05). Mean followup for 120 patients was 80.6 months and 15 of 87 patients with RCC (17.2%) died of tumor related causes (mean followup 27.5 months). The 10-year cancer specific survival rate was 78% in young adults and 68% in older patients (p = 0.22). Multivariate Cox regression analysis revealed lymph node metastases and tumor differentiation grade as independent prognostic parameters in young patients.

Conclusions: Young patients are more likely to have symptomatic tumors at presentation. Nevertheless, they have more favorable pathological features and a definite trend to superior disease specific survival following surgical treatment. Organ sparing surgery should be considered in young women since benign lesions are frequent found in this population.