RENAL-CELL CARCINOMA IN CHILDHOOD AND ADOLESCENCE - A RETROSPECTIVE SURVEY FOR PROGNOSTIC FACTORS IN 22 CASES

dTo identify prognostic factors for renal carcinoma in young patients, a retrospective analysis was performed of 22 patients (less than or e qual to 21 years of age) with histologically verified renal cell carci noma. Demographic, staging, and treatment variables were collected in a database, and their effect on survival was determined using Kaplan M eier probability distribution. The median age was 15.5 years (range, 3 to 21 years), and the male:female ratio was 13:9. Only three patients were black. Histopathologic examination showed 15 clear cell tumors, 4 mixed cell type, 2 papillary, and one well-differentiated adenocarci noma. The median size of the primary tumor was 10 cm (range, 5 to 20). There were seven patients with stage I tumors, one with stage II, and 14 with stage IV. Complete resection of the primary tumor was accompl ished in 12 patients. The overall B-year survival rate was 30% (confid ence interval, 20% to 40%). The 5-year survival rate was better for pa tients who had complete resection of the primary tumor (60% v 10%). Un resectability was associated with involvement of nodes and/or occur re nce of metastases, thus an independent effect of complete resection on survival could not be demonstrated. The data showed that age, tumor s ize, location, and histology were not predictors of outcome; tumor sta ge and complete surgical resection were the only meaningful prognostic factors. The presentation of renal cell carcinoma as a localized or s ystemic disease may reflect a twofold biological behavior. In the firs t group, the disease is curable with resection, in the second, it is u naffected by surgery or adjuvant therapy. In light of the very low inc idence of this renal malignancy in childhood, prospective multicenter studies will be required to improve the poor therapeutic results. Copy right (C) 1996 by W.B. Saunders Company.