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Renal cell carcinoma, western India, Epidemiology, minimally invasive surgery
Renal cell carcinoma (RCC) accounts for 3% of all adult cancers and 85% of all kidney tumours. Incidence of RCC is lower in Asian region, particularly in India, probably due to lack of reporting. Most of the data about RCC are from Western countries; and data from India are scarce, especially regarding para-neoplastic syndromes. We sought to determine the epidemiology, clinicopathological profile and management of RCC in a tertiary care centre in Western India.
This was a retrospective study that involved data analysis of records of RCC patients who presented to our institution from April 2016 to Feb-ruary 2020. Laboratory investigations, including tests for paraneoplastic syndrome (PNS), and relevant radiologic investigations were performed and treatment was offered according to the stage, patient factors and available modalities.
A total 142 RCC patients were included in the study. The median age of presentation was 58 years. Most of the patients (67%) were symptom-atic, and 33% of the patients were asymptomatic, and the RCC was diagnosed incidentally. A large number of patients (56.3%) had PNS. The most common histopathologic type of RCC was clear cell carcinoma (68.8%), followed by papillary (20%) and chromophobe (8%) carcinoma. 40% of carcinomas with sarcomatoid differentiation were seen in patients under 50 years of age. Two cases of multicystic RCC were both seen in patients less than 50 years of age. 65.5% of the patients presented at Stage 1 and 2. Most surgeries (71.2%) were done in a minimally invasive manner.
A significant number of patients were asymptomatic, in which RCC was detected incidentally. The age of presentation was earlier, yet the patients had a higher tumour stage. More than half of the patients had PNSs. Despite growing trend towards Western data, the significantly higher number of patients with PNSs and early age of presentation suggest inherent differences in tumour biology, possibly related to differences in genetic and environmental factors.
2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394–424. http:// dx.doi.org/10.3322/caac.21492
3. Khandelwal S, Reddy KS. Eliciting a policy response for the rising epidemic of overweight-obesity in India. Obes Rev. 2013 Nov;14:114–25. http://dx.doi.org/10.1111/obr.12097
4. Joshi A, Anand A, Prabhash K, Noronha V, Shrirangwar S, Bakshi G, et al. Kidney cancer demographics and outcome data from 2013 at a tertiary cancer hospital in India. Indian J Cancer. 2017 Oct 1;54(4):601. http://dx.doi.org/10.4103/ijc.IJC_644_17
5. Amin MB, Edge SB, editors. AJCC cancer staging manual. New York; Springer: 2017.
6. Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z. 2004 WHO classification of the renal tumors of the adults. Eur Urol. 2006 May 1;49(5):798–805. http://dx.doi.org/10.1016/j. eururo.2005.11.035
7. Thompson RH, Ordonez MA, Iasonos A, Secin FP, Guillonneau B, Russo P, et al. Renal cell carcinoma in young and old patients—Is there a difference? J Urol. 2008 Oct;180(4):1262–6. http://dx.doi.org/10.1016/j.juro.2008.06.037
8. National Cancer Institute. SEER Stat fact sheets: Kidney and renal pelvis. [Internet]. Available at: https://seer.cancer.gov/stat-facts/html/kidrp.html
9. Agnihotri S, Kumar J, Jain M, Kapoor R, Mandhani A. Renal cell carcinoma in India demonstrates early age of onset & a late stage of presentation. Indian J Med Res. 2014 Nov;140(5):624.
10. Ray RP, Mahapatra RS, Khullar S, Pal DK, Kundu AK. Clinical characteristics of renal cell carcinoma: Five years review from a tertiary hospital in Eastern India. Indian J Cancer. 2016 Jan 1;53(1):114. http://dx.doi.org/10.4103/0019-509X.180851
11. Singam P, Ho C, Hong GE, Mohd A, Tamil AM, Cheok LB, et al. Clinical characteristics of renal cancer in Malaysia: A ten-year review. Asian Pac J Cancer Prev. 2010 Jan1;11(2):503–6.
12. Kim H, Cho NH, Kim DS, Kwon YM, Kim EK, Rha SH, et al. Renal cell carcinoma in South Korea: A multicenter study. Hum Pathol. 2004 Dec 1;35(12):1556–63. http://dx.doi.org/10.1053/j. humpath.2004.06.011
13. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell-Walsh urology: Expert consult premium edition: Enhanced online features and print, 4-volume set. Toronto, Canada: Elsevier Health Sciences; 2011.
14. Choudhary GR, Mandal AK, Mete U, Mavuduru R, Bhatacharia A, Lal A, et al. Evaluation of quantitative and qualitative renal outcome following nephron sparing surgery. J Clin Imaging Sci. 2018;8:15. http://dx.doi.org/10.4103/jcis. JCIS_82_17
15. Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F. International variations and trends in renal cell carcinoma incidence and mortality. Eur Urol. 2015 Mar 1;67(3):519–30. http:// dx.doi.org/10.1016/j.eururo.2014.10.002
16. Lipworth L, Tarone RE, McLaughlin JK. The epidemiology of renal cell carcinoma. J Urol. 2006 Dec;176(6):2353–8. http://dx. doi.org/10.1016/j.juro.2006.07.130
17. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020 Jan;70(1):7–30. http://dx.doi.org/10.3322/ caac.21590
18. Pang C, Guan Y, Li H, Chen W, Zhu G. Urologic cancer in China. Japanese J Clin Oncol. 2016 Jun 1;46(6):497–501. http:// dx.doi.org/10.1093/jjco/hyw034
19. Goggins WB, Wong G. Cancer among Asian Indians/Pakistanis living in the United States: Low incidence and generally above average survival. Cancer Causes Control. 2009 Jul 1;20(5):635– 43. http://dx.doi.org/10.1007/s10552-008-9275-x
20. Silverman SG, Israel GM, Herts BR, Richie JP. Management of the incidental renal mass. Radiology. 2008 Oct;249(1):16–31. http://dx.doi.org/10.1148/radiol.2491070783
21. Sacco E, Pinto F, Sasso F, Racioppi M, Gulino G, Volpe A, et al. Paraneoplastic syndromes in patients with urological malignan-cies. Urol Int. 2009;83(1):1. http://dx.doi.org/10.1159/000224860
22. Palapattu GS, Kristo B, Rajfer J. Paraneoplastic syndromes in urologic malignancy: The many faces of renal cell carcinoma. Rev Urol. 2002;4(4):163.
23. Men H, Liang C, Yu M. Thrombocytosis as a prognostic factor in patients with renal cell carcinoma: A meta-analysis of liter-ature. J Cancer Res Therap. 2015 Jan 1;11(1):67. http://dx.doi. org/10.4103/0973-1482.150345
24. Patard JJ, Tazi H, Bensalah K, Rodriguez A, Vincendeau S, Rioux-Leclercq N, et al. The changing evolution of renal tumours: A single center experience over a two-decade period. Eur Urol. 2004 Apr 1;45(4):490–4. http://dx.doi.org/10.1016/j. eururo.2003.12.015
25. Verhoest G, Veillard D, Guillé F, De La Taille A, Salomon L, Abbou CC, et al. Relationship between age at diagnosis and clinicopathologic features of renal cell carcinoma. Eur Urol. 2007 May 1;51(5):1298–305. http://dx.doi.org/10.1016/j. eururo.2006.11.056
26. Sanchez-Ortiz RF, Rosser CJ, Madsen LT, Swanson DA, Wood CG. Young age is an independent prognostic factor for survival of sporadic renal cell carcinoma. J Urol. 2004 Jun;171(6 Part 1):2160–5. http://dx.doi.org/10.1097/01. ju.0000125487.96469.2e