The presentation, treatment and outcome of renal cell carcinoma in old age

Abstract

Objective: to review clinical presentation and outcome of patients with a diagnosis of renal cell carcinoma at a district general hospital and assess whether older patients were more likely to present in a non-specific manner or receive more conservative management and whether their survival was less favourable. Subjects and methods: 39 patients presenting with a diagnosis of renal cell carcinoma between 1987 and 1995 were identified from hospital activity analysis data and histopathology records. We divided the subjects into young patients (< 69 years: n = 27) and elderly patients (>70 years: n = 10), and made a retrospective analysis of clinical features, laboratory results, pathology, staging, treatment and survival from hospital records. Results: anaemia, hypertension and weight loss were common clinical features in both young and elderly groups. The prevalence of non-urological symptoms did not differ between study groups. Anaemia was frequently microcytic and hypochromic. Hypertension was present in 46% of patients and one-third of these were newly diagnosed. In 19% of patients with renal cell carcinoma, the diagnosis was made incidentally while imaging for other indications. Elderly patients were as likely to receive surgical treatment as younger patients. Survival differed with stage but not age. Conclusions: neither clinical presentation, management nor survival differed between the young and elderly subjects. Renal cell carcinoma should be considered in elderly patients with systemic features such as malaise or weight loss associated with anaemia, hypertension and raised erythrocyte sedimentation rate.

Experimental and Clinical Evaluation of Transperitoneal Laparoscopic Ureteronephrectomy in Dogs

“…The most common canine renal tumors are epithelial in origin with renal tubular carcinoma accounting for 65% of renal tumors in 1 study; however, neoplasia is not the most common indication for nephrectomy in dogs and many cases do not present early in the course of disease . Consequently renal tumors are often very large before they produce noticeable clinical signs such as hematuria, a common finding in people (occurring in up to 50% of cases) but an inconsistent one in dogs . It is therefore likely that a laparoscopic approach may be challenging in many cases of renal neoplasia in dogs unless they are diagnosed early in the course of the disease as occurred with the 2 neoplastic lesions in this case series.…”

Efficacy and safety of sunitinib in elderly patients with metastatic renal cell carcinoma

“…Patients with RCC ⩾65 years account for ∼50% of those diagnosed in the United States of America and almost 70% of those dying from this tumor (Altekruse et al , 2010). Several studies have suggested that increasing age is an adverse prognostic factor in RCC, with older age associated with higher tumor stage and grade (Denzinger et al , 2007; Verhoest et al , 2007; Karakiewicz et al , 2008; Jung et al , 2009), although others have found that age has little impact on presentation or survival (Doherty et al , 1999; Thompson et al , 2008; Scoll et al , 2009). In general, survival tends to be poorer in older cancer patients (Bouchardy et al , 2003; Petignat et al , 2004; Quaglia et al , 2009; Janssen-Heijnen et al , 2010), reflecting a complex picture of less frequent referral to cancer specialists (Tyldesley et al , 2000; Delva et al , 2011); inadequate treatment (Mor et al , 1985; Earle et al , 2002; Easson et al , 2002; Bouchardy et al , 2003; Houterman et al , 2006; Vulto et al , 2006); and impact of comorbidities (Extermann, 2007), since older patients are at significant risk for multiple comorbidities (e.g., 35% of patients age 65 years or older who are eligible for both US Medicare and Medicaid have ⩾4 comorbidities (Fox and Reichard, 2013)).…”

Sorafenib for Older Patients With Renal Cell Carcinoma: Subset Analysis From a Randomized Trial

“…Although more data are needed, current evidence indicates that age has a minimal influence on the nature and treatment of advanced renal cell carcinoma. Older (>70 years) and younger (≤70 years) patients diagnosed with renal cell carcinoma present with similar clinical and laboratory features, incidences of nephrectomy, and probabilities of survival ( 11 ). A moderately greater mortality rate has been observed in some older patient populations with advanced renal cell carcinoma, perhaps because older patients in these studies were at a more advanced stage at diagnosis ( 12 ).…”