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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 8  |  Issue : 2  |  Page : 59-62

Peculiarities of renal cell carcinoma in young adults


Department of Surgery, Ahmadu Bello University, Teaching Hospital, Zaria, Nigeria

Date of Web Publication30-May-2019

Correspondence Address:
Dr. Nasir Oyelowo
Department of Surgery, Ahmadu Bello University, Zaria, Kaduna
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ais.ais_33_18

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  Abstract 


Background: We observed an increase in incidence of sporadic renal cell carcinoma in young adults (< 40years). The presentation and outcome seems to be different from those in the elderly. We retrospectively reviewed the clinical presentations, pathological findings, management and outcomes in these patients as well as comparison with those in older patients.
Patients and Methods: The age, clinical presentation, pathological findings and outcomes following treatment of patients diagnosed and managed for renal cell carcinoma at this center from January 2008 to January 2017 were retrieved from hospital records and analyzed. Patients where divided into young adults (< 40 years) or older adults (> 40 years).
Results: A total of 61 patients were reviewed within the period with young adults n = 25 (41%) vs older adults n = 36 (59%). A male:female ratio of 2:1 was found in both groups. Flank pain (77.8% in older adults compared to 72% in young adults) and Hematuria (63.9% of Older adults compared to 52.0% of Young adults.) were both higher in older adults but not statistically significant with P values not <0.05 however Flank mass (100% in older adults and 72.0% in younger adults) was also higher in older adults as well as statistically significant with P value of 0.001. Metastasis and stage of the diseases were equally statistically significantly higher in older adults with P values 0.001. Mean 5 year survival in months for young adults was 25 months (56-3 months) and older adults was 15 months (45- 5 months).
Conclusion: Sporadic RCC in young adults presents commonly with an early disease. It seldoms presents with flank mass as compared to the older adults. Hematuria, flank pain and histological type and grade occurs in similar distribution in both groups survival was better in the young.

Keywords: Renal cell Carcinoma, survival, young adults


How to cite this article:
Ahmed M, Oyelowo N, Bello A, Lawal AT, Maitama HY, Abdulsalam K, Tolani AM. Peculiarities of renal cell carcinoma in young adults. Arch Int Surg 2018;8:59-62

How to cite this URL:
Ahmed M, Oyelowo N, Bello A, Lawal AT, Maitama HY, Abdulsalam K, Tolani AM. Peculiarities of renal cell carcinoma in young adults. Arch Int Surg [serial online] 2018 [cited 2019 Jun 25];8:59-62. Available from: http://www.archintsurg.org/text.asp?2018/8/2/59/259459




  Introduction Top


Renal cell carcinoma (RCC) is the most deadly urological malignancy and accounts for 3% of oncological diseases in men.[1] It occurs in sporadic and familial forms. The familial RCC occurs more in the young, usually bilateral and multifocal, with a propensity for high-grade tumors. The sporadic form occurs mainly in the sixth and seventh decade of life. It is usually unilateral and has a fairly predictable and favorable course; however, its clinical presentation tends to vary with age.[2] An insidious onset and late presentation were documented in the older adults.[3]

The histological type as well as biological behavior of sporadic renal carcinoma also varies with age.[4] This may influence therapy as well as survival in these patients. In literature, the findings are conflicting. Some studies have shown that the clear cell type, lower stage tumors, and better prognosis tends to be more in the young adults whereas others found the contrary.[5]

There is an increase in the incidence of sporadic RCC in the younger adults (age <40 yrs) in our environment.[6] We hereby aim to review the clinical presentation, histological findings, and survival in them and compare with presentations in the older adults (age >40 yrs.).


  Patients and Methods Top


We retrospectively reviewed the medical records of all the patients that were managed at Ahmadu Bello University Teaching Hospital Zaria for RCC from January 2008 to January 2017. The clinical presentation including extent of disease as well as pathological findings was reviewed. Patient follow-up, last presentation at the clinic postnephrectomy, and survival were assessed from the medical records. Those with incomplete records were excluded from the study.

Patients were classified as young adults (<40 yrs) and older adults (>40 yrs). Findings were displayed in tables and charts. Using SPSS version 15.0, test of statistical significance was done using Chi-square test and value is significant if P Value is > 0.05.


  Results Top


A total of 61 patients were reviewed over the period. Twenty five patients were young adults (age <40 years), with the youngest being 15 years old, whereas 36 patients were in the older adults group having a 70 year old as the eldest. There was a similar sex distribution of RCC in both groups with a female preponderance noted, young adults (male 36% females 64%) and older adults (males 38.8%, females 61.2%). There was also a right sided predominance in presentation in both groups, young adults (right 76% and left 24%) and older adults (right 65.7% and left 34.3%). Flank mass was present in all older adults and 78% of young adults. This was statistically significant (P = 0.006). The clinical features of RCC in both groups are summarized [Table 1].
Table 1: Clinical Features of Young Adults (<40 yrs) and Older Adults (>40 yrs) with RCC

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Clear cell RCC was seen slightly higher in the young adults (60%) than in older adults (58.4%); however, papillary RCC was found slightly more in the older adults (19.4%) compared with young adults (12%). From the study, the statistically significant pathologic findings (nodal or distant metastasis) were found in 88.9% of older adults and only 20% of young adults. Stage 2 (early disease) was found predominately in the younger adults (72%) than in older adults (11.1%), whereas the opposite was found in Stage 4 disease (late disease) with 16% in young adults and 72% in older adults. The pathological findings in both groups are summarized in the [Table 2].
Table 2: The Pathological features in Young Adults (<40 yrs) and Older adults (>40 yrs)

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Mean follow-up time for the young adults was 25 months (range 3--56 months), whereas for the older adults its 11 months (range 5--45 months). The 5 years survival analysis using Kaplan Meier was 46% for young adults and 26% for older adults and a mean survival time of 30 months for young adults and 22 months for older adults [Figure 1], which was not statistically significant as shown [Table 3].
Figure 1: The Kaplan-Meier Survival Curve Post Nephrectomy

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Table 3: Survival time for Young and Older adults

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  Discussion Top


The incidence of sporadic RCC is on the rise in Nigeria, this may be attributable to the observed increased diagnosis of incidental tumors, which is usually seen in young adults.[7] Although the mean age at diagnosis in most literature is the sixth decade of life, there is an observed increase in the percentage of RCC in young adults.[1] The mean age of patients from this study is 44 years, which is similar to findings by Badmus et al. and Aghaji et al. with mean age at presentation of 47 and 44 years, respectively.[8],[9] Young adults (<40 yrs) accounted for 40% of the total patient seen, a higher percentage compared with 5.2% was seen by Suh et al. of Weil medical College, Corneil University Houston in 2009.[10] A female to male ratio of 2: 1 was found in this study contrary to most other studies although Gozel et al. had a similar observation.[1],[11]

In our study, flank mass was seen in all older adults compared with only 78% in young adults. This finding was statistically significant with P = 0.006. Flank pain and hematuria, the other components of the “too late triad,” were also seen more in the older adults at 87.5% and 71.9%, respectively, compared with the young adults. The potential reason for this finding is that older adults are usually symptomatic at presentation in our environment. This is however not in keeping with the findings in Germany by Siemer et al. who had younger adults presenting more with symptoms. In their series, older adults presented more for screening and were usually asymptomatic at presentation compared with the younger adults.

Similar to other recent studies on renal cell cancer, we observed a statistically significant finding of presentation at early disease and lower stages in younger adults than older adults. Lymph node and other metastasis were more in older adults too.[10],[12],[13]

There have been inconsistencies in the incidence of histopathologic subtypes of RCC among adults.[14] We found clear cell RCC slightly lower in young adults compared with older adults and papillary RCC more in older adults, although these findings were not significant. Gillete et al. found a similar lower incidence of clear cell RCC in young adults compared with older adults.[15] In the analysis of renal neoplasms in 112 adults, Cao et al. found a higher percentage of clear cell RCC in young adults.[16] Eggenner et al. and Chang in China as well as Suh in India had similar proportion of young adults presenting with clear cell RCC.[10],[17],[18] Naggada et al. reviewed the histopathological findings in postnephrectomy specimens of young adults. They found more of chromophobe and collecting duct RCC in the younger adults.[19]

Renal cell cancer being a lethal disease, the lower stage at presentation in younger adults compared with older adults did not translate so much into improved survival. The difference in survival times in both groups was not significant. This is similar to most studies on RCC in the young.[20],[21],[22]


  Conclusion Top


There is an increase in incidence of sporadic RCC in young adults, with more of asymptomatic disease and lower stage at presentation as compared with older adults in our environment. Similar to findings in other parts of the world, this does not imply improved survival in the younger adults as compared with the older ones and RCC is obviously a lethal disease irrespective of age or stage at presentation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Muhammed A, Ahmad B, Yusuf MH, Almustapha LA, Abdullahi S. Pathologic characteristics and management of renal cell carcinoma in Zaria, Nigeria. Sub Saharan African J Medicine 2015;2:1-4.  Back to cited text no. 1
    
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Swanson CG, Samuel DW. Young age is an Independent prognostic factor for survival of sporadic renal cell carcinoma. J Urol 2004;171:2160-5.  Back to cited text no. 2
    
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Doherty T, JohnGD, Xel ARU. The presentation, treatment and outcome of renal cell carcinoma in old age. J Urol 1999;359-62.  Back to cited text no. 3
    
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Schiff M, Jr, Herter G, Lytton B. Renal adenocarcinoma in young adults. Urology 1985;25:357-9.  Back to cited text no. 4
    
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Rainwater LM, Zincke H, Farrow GM, Gonchoroff NJ. Renal cell carcinoma in young and old patients. Comparison of prognostic and pathologic variables and their impacton disease outcome. J Urol 1991;38:1-5.  Back to cited text no. 5
    
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Akpayak IC, Shuiabu SI, Ofoha CG, Dakum NK, Ramyil VM. Presentation and management of renal cell carcinoma: A 7- year review. IOSR-JDMS 2015;14:16-9.  Back to cited text no. 6
    
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Tijani KH, Anunobi CC, Ezenwa EV, Lawal A, Habeebu MYM, Jeje EA, et al. Adult renal cell carcinoma in Lagos: Experience and challenges at the Lagos University Teaching Hospital. J Adv Res 2012;18:20-3.  Back to cited text no. 7
    
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Badmus TA. Salako AB. Malignant renal tumors in adults a ten-year revie in a Nigerian teaching hospitaL. Saudi J Kidney Dis Transpl 2008;19:120-6.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Aghaji AE, Odoemene CA. Renal cell carcinoma in Enugu, Nigeria. West Afr J Med 2000;4:254-8.  Back to cited text no. 9
    
10.
Suh JH, Oak T, Ro JY, Truong LD, Ayala AG, Shen SS. Clinicopathologic features of renal cell carcinoma in young adults: A comparison study with renal cell carcinoma in older patients. Indian J Urol 2009;44:489-93.  Back to cited text no. 10
    
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Goetzl MA, Desai M, Mansukhani M, Goluboff ET, Katz AE, Sawczuk IS, et al. Natural history and clinical outcome of sporadic renal cortical tumors diagnosed in the young adult. Urology 2004;63:41-5.  Back to cited text no. 11
    
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Rodríguez A, Patard JJ, Lobel B. Renal cell carcinoma in young adults: Incidence, disease outcome and review of the literature. Arch Esp Urol 2002;55:969-75.  Back to cited text no. 12
    
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Agnihotri S, Kumar J, Jain M, Kapoor R, Mandhani A. Renal cell carcinoma in India demonstrates early age of onset and a late stage of presentation. Indial J Med 2014;7:624-9.  Back to cited text no. 13
    
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Taccoen X, Valeri A, Descotes J, Morin V, Stindel E, Doucet L, et al. Renal cell carcinoma in adults 40 years old or less: Young age is an independent prognostic factor for cancer-specific survival. Eur Urol 2007;51:980-7.  Back to cited text no. 14
    
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Gillett MD, Cheville JC, Karnes RJ, Lohse CM, Kwon ED, Leibovich BC. Comparison of presentation and outcome for patients 18 to 40 and 60 to 70 years old with solid renal masses. J Urol 2005;173:1893-6.  Back to cited text no. 15
    
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Cao Y, Paner GP, Perry KT, Flanigan RC, Campbell SC, Picken MM. Renal neoplasms in younger adults analysis of 112 tumors from a single institution according to the new 2004 World Health Organization classification and 2002 American Joint Committee on Cancer Staging System Arch Pathol Lab Med 2005;129:487-91.  Back to cited text no. 16
    
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Tsai H, Chin T, Chang J, Liu C, Wei C. Renal cell carcinoma in children and young adults. J China Med 2006;69:240-4.  Back to cited text no. 17
    
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Eggener SE, Rubenstein JN, Smith ND, Nadler RB, Kontak J, Flanigan RC, et al. Renal tumors in the young. J Urol 2004;171:106-9.  Back to cited text no. 18
    
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Nggada HA, Eni UE, Nwankwo EA. Histopathological findings in nephrectomy specimens — A review of 42 cases. Niger Postgrad Med J 2006;13:244-6.  Back to cited text no. 19
    
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Klufio GO. A review of genitourinary cancers at the Korle-Bu teaching hospital Accra, Ghana. West Afr J Med 2004;23:131-4.  Back to cited text no. 20
    
21.
Walter M, Wetterauer C, Bruder E, Obermann EC, Subotic S, Wyler S. Urology case reports renal cell carcinoma in a young adult e do we need further investigations ? Urol Case Rep 2016;6:27-9  Back to cited text no. 21
    
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Xu L, Yang R, Gan W, Chen X, Qiu X, Fu K, et al. Renal cell carcinoma in young adults. J China Med Assoc 2015;1-6.  Back to cited text no. 22
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Patients and Methods
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