BILATERAL NONFAMILIAL RENAL-CELL CARCINOMA

Background: Bilateral renal cell carcinoma (RCC) exists in hereditary forms (von Hippel-Lindau disease, hereditary papillary renal cell carc inoma, and hereditary clear cell renal carcinoma) associated with vari ous chromosomal abnormalities, and non-hereditary, apparently sporadic forms. The focus of this study is the clinical description of the lat ter entity. Methods: Synchronous and asynchronous bilateral RCC were i dentified from a prospective database of 698 consecutive patients unde rgoing operation for RCC between July 1989 and December 1997 at Memori al Sloan-Kettering Cancer Center. Non-familial RCC was defined as that occurring in those patients without a family or hereditary history of RCC, Patients' records were evaluated for presentation, surgical appr oach used, and pathology. Actuarial survival from the date of initial operative treatment until the dare of last follow-up or death was dete rmined using the Kaplan-Meier method. Comparisons between groups were made using the Mann-Whitney test. Results: Thirty-three of 698 (4.7%) patients operated for RCC had bilateral disease. Four of the 33 (12.1% ) patients had either VHL or documented hereditary RCC, and 29 of 33 ( 87.9%) had non-familial RCC. Of the 29 patients, histology was convent ional (clear cell) in 17 patients, papillary in 5, oncocytoma in 3, an d unclassified in 3. One patient had a conventional (clear cell) histo logy in the first nephrectomy specimen and chromophobe renal cell carc inoma in the second. Partial nephrectomy was used in 100% of patients. Median follow-up time was 52 months. Actuarial 5-year overall surviva l was 84.5%, and actuarial disease-specific survival was 93.3% at 5 ye ars for the non-familial RCC patients. Conclusions: Non-familial bilat eral RCC patients represent a distinct subpopulation of renal cancer p atients with a good overall prognosis. Pal tial nephrectomy is an inte gral part of the surgical management. Although most bilateral tumors p resent synchronously, asynchronous lesions may occur many years after original nephrectomy, thus committing the patient to long-term follow- up.