A CLINICAL STUDY ON RENAL CELL CARCINOMA

Abstract

Sixty three cases admitted to the Osaka University Hospital during the past nineteen years with renal cell carcinoma were studied with regard to their clinical manifestations, histopathological findings and prognostic features. The results obtained were as follows.
1. There were 50 males with an average of 55.7 years old and 13 females with that of 45.7, with a ratio of 3.8:1.
2. In our series, the most frequent symptoms were hematuria (75%), palpable mass (46%), and fever (22%). The classical triad of hematuria, pain and mass were observed only in 6 patients (10%).
3. Laboratory findings of the cases showed elevated ESR in 52%, anemia in 25%, leucocytosis in 17% and leucocytopenia in 24%. Peripheral blood lymphocyte count was below normal limit in 24%. High serum calcium and alkaline phosphatase were observed in 7% and 21% respectively.
4. The weight of the tumor was over 500g in 46%, and marked local spread beyond the renal capsule (high stage) was seen in 39%. Metastases were found in 10 patients (16%) at the time of the first visit and renal vein involvement were revealed in 19%.
5. Histopathological examination revealed grade 1 or 2 in 25 cases, grade 3 in 27 cases, grade 4 in 11 cases, according to the classification presented by Skinner et al. Concernig the cell type, clear cell carcinoma was in 36 cases, granular cell carcinoma in 17 cases and mixed cell type in 10 cases.
6. The five year survival rate of our series was 42%. Several factors influencing prognosis were analysed and tumor weight, local extention, malignancy grading, metastases, renal vein involvement, all of which were considered to have important mean for the prognosis of the disease. Elevated ESR and fever also seemed to indicate poor prognosis.
7. Operative extirpation of the tumor was a radical treatment only for the cases of low grade, low stage and tumor weight below 500g, without any metastases or renal vein involvement.