Changing prognosis of renal cell carcinoma: a single-centre experience over 25 years

Objective: The objective of this research is to examine renal cancer nephrectomies over 25 years in our centre and the factors underlying changes in disease-specific survival. Patients and methods: Retrospective data analysis was performed on all patients undergoing nephrectomies at our institution for renal cell carcinoma (RCC) from 1983 to 2007. Data extracted from the Cancer Research Uro-Oncology Database (CRUD(C)) provided survival, clinical and prognostic information including tumour diameter, Fuhrman grade, WHO staging and age. Results: Analysis of 664 RCCs demonstrated a clear change in kidney cancer-specific survival over the past 25 years, with five-year survival improving from 42% (1983-1986) to 73% (1999-2002). The number of RCC nephrectomies has increased 10 fold. There was no significant change in operative mortality, age, grade, stage or mean tumour size. However, there was a five-fold increase in tumours < 6 cm, corresponding to an equal-fold decrease in tumours 6-8 cm, but no change in tumours > 8 cm. Tumour size > 8 cm was a significant adverse prognostic marker. Conclusions: A 30% improvement in RCC cancer-specific survival has been seen in our centre over the last 25 years. This change relates to a shift to smaller tumours, lower histological grades and a higher volume of cases.