1986 Volume 77 Issue 10 Pages 1618-1622
Between January 1975 and December 1984, 182 patients with renal cell carcinoma were treated at the Jikei University Hospital, and 117 (64.3%) died. After undergoing nephrectomy, 55 died of cancer. These 55 patients were reviewed in relation to 1) the mean age at death, sex incidence and clinical symptoms at the first medical consultation, 2) the clinical data concerning the stages and pathological grades, 3) the period until first clinical recurrence after nephrectomy and the period until death after the cancerous recurrence, 4) all clinical laboratory findings at three clinical phases (preoperative phase, postoperative phase and the phase before death).
The 55 patients' mean age at death was 58.7 years, which is lower than in the case of prostatic cancer. There were 4 times as many men as women, which was greater than the sex ratio for the 182 cases of renal cell carcinoma, i. e., 2-3 times as many men as women. The clinical symptoms at the first consultation could be classified into urological symptoms (56.4%), which includes hematuria, palpable renal mass and renal pain, and nonurological symptoms (43.6%), which includes paraneoplastic symptoms. There was a difference between the patients of cancer death and all affected patients.
Analysis of the stage and pathological grade for the 55 patients showed that there were 37 cases of a high stage (67.3%) and 41 cases of a high grade (74.6%), indicating that there was a tendency for the fatal cases to have a high stage and a high grade. But in the analysis of the period from nephrectomy until death, there was no significant difference between the low stage and high stage cases or the low grade and high grade cases.
Blood samples for CRP, α2-globulin and erythrocyte sedimentation rate determinations were obtained for two different stage groups (low stage group and a high stage group) preoperatively, postoperatively and before death. Nephrectomy resulted in a higher rate of normalization of these acute phase criteria in the low-stage patients than in the patients with a high stage. There was also observed a high frequency of elevated acute phase parameters in the preoperative phase and the phase before death. So these biochemical criteria may be useful for the detection of a recurrent tumor.
In order to improve the prognosis of renal cell carcinoma, not only radical nephrectomy is necessary for low-stage patients: early monitoring of thse criteria after the radical nephrectomy is also essential. If these criteria are elevated, systemic chemotherapy must be administered.
