Effect of Symptom Graduation on Oncologic Outcomes in Patients with Renal Cell Carcinoma and Hematuria

Aims: Symptoms associated with renal cell carcinoma characterize high-risk disease. Hematuria is the most common symptom and usually occurs as a result of urothelial invasion. The objective of this study was to evaluate the prognostic value of progressive symptomatic disease in patients with kidney cancer.

Place and Duration of Study: Sao Paulo Cancer Institute at University of Sao Paulo School of Medicine between 2005 and 2009.

Methodology: Data was prospectively recorded at our database and retrospectively reviewed. Sixty-six individuals who presented with macroscopic hematuria were included in our analysis. Patients were divided into three groups: (1) Exclusive hematuria (27 patients), (2) Hematuria associated with another symptom (23 patients), and (3) Hematuria associated with two or more symptoms. We evaluated these groups for histopathology, kidney function, recurrence, and survival characteristics.

Results: Mean tumor diameter was 8.5 cm, 11 cm and 13.4 cm for groups (1), (2) and (3). Recurrence-free survival was 89%, 91%, and 69% and overall survival was 96%, 79%, and 56% for groups (1), (2) and (3), respectively. The mean follow-up time was 97.6 months and the disease-free survival rate was 84.8%. Cox regression analysis showed a death risk 10.5 times higher in group (3) when compared to Group (1).

Conclusion: Association of two or more symptoms with hematuria impairs prognosis of patients surgically treated for kidney cancer.