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Laterality of Renal Cell Carcinoma Predicts Survival in Certain Patient Subgroups

Key findings

  • In a retrospective, population-based study of 41,138 patients, those with right-sided renal cell carcinoma (RCC) were more likely than those with left-sided RCC to have early-stage tumors and low tumor grade
  • Tumor size >4 cm and the need for only partial nephrectomy were also significantly more likely in right-sided RCC
  • In univariate analysis, cancer-specific survival was better with right-sided RCC in patients with tumors =10 cm, age <65, male gender, white race, clear cell carcinoma, grade 3 differentiation, no lung or bone metastasis and radical nephrectomy
  • Laterality was an independent prognostic factor for cancer-specific survival in patients with tumors =10 cm

A number of factors are known to affect prognosis in renal cell carcinoma (RCC), such as age, grade and tumor size. Studies conflict, however, about how primary tumor location influences survival.

In the largest study yet to evaluate the effect of laterality in RCC, Chin-Lee Wu, MD, PhD, associate pathologist and director of Genitourinary Pathology Services at Massachusetts General Hospital and the Mass General Cancer Center, Shulin Wu, MD, PhD, lab manager of the Urology Pathology Research Laboratory, and colleagues determined that right-sided cancer was independently associated with better survival in patients with tumors ≥10 cm. Their findings are published in Cancer Medicine.

Study Participants

The researchers examined records on 41,138 patients with RCC, included in the Surveillance, Epidemiology, and End Results database of the U.S. National Cancer Institute, who underwent partial or radical nephrectomy between January 2010 and December 2014. Most patients were younger than 65 (60%), male (64%) and diagnosed with stage I or II disease (77%), and most had undergone radical nephrectomy (61%).

Disease Characteristics

As in prior research, tumors were nearly equally distributed between the right and left kidneys (51% right-sided, 49% left-sided).

Compared with patients who had right-sided RCC, those with left-sided disease were significantly more likely to have advanced cancer (stage III or IV), tumor size ≥4 cm, lymph node metastasis, organ metastasis and poorly differentiated tumors.

Cancer-specific Survival

On multivariate analysis, laterality had no significant effect on cancer-specific survival (CSS).

On univariate subgroup analysis, certain characteristics were associated with significantly better CSS in patients with right-sided RCC compared with left-sided disease. They are:

  • Age under 65 at diagnosis (HR, 0.84)
  • Male gender (HR, 0.85)
  • White race (HR, 0.86)
  • Tumor =10 cm (HR, 0.83)
  • Clear cell carcinoma (HR, 0.88)
  • Grade 3 differentiated tumor (HR, 0.85)
  • No lung metastasis (HR, 0.89)
  • No bone metastasis (HR, 0.86)
  • Underwent radical nephrectomy (HR, 0.89)

On multivariate subgroup analysis, CSS did not differ according to age, race, pathology, grade or type of surgery. However, on multivariate subgroup analysis by tumor size, right-sided cancer was an independent predictor of CSS in patients with tumors ≥10 cm (HR, 0.85; 95% CI, 0.75–0.97; P = .02). Other independent prognostic factors were stage, histology and grade.

The authors also report that the one-year and 48-month survival rates were 95% and 90%, respectively. By comparison, they say, in 1994 study published in Urology by a team from Wellington School of Medicine, the one-year survival rate was 61%. They attribute the improvement to earlier diagnosis of RCC, advances in surgical techniques and the advent of targeted therapy.

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