Prognostic impact of paraneoplastic syndromes on patients with nonmetastatic renal cell carcinoma undergoing surgery: Results from Canadian Kidney Cancer information system

  • Ryan Sun University of Manitoba
  • Rodney H. Breau
  • Ranjeeta Mallick
  • Simon Tanguay
  • Frederic Pouliot
  • Anil Kapoor
  • Luke T. Lavallée
  • Antonio Finelli
  • Alan I. So
  • Ricardo A. Rendon
  • Adrian S. Fairey
  • Jean-Baptiste Lattouf
  • Jun Kawakami
  • Bimal Bhindi
  • Naveen S. Basappa
  • Lori A. Wood
  • Georg A. Bjarnason
  • Daniel Y. C. Heng
  • Rahul K. Bansal University of Manitoba
Keywords: RCC, paraneoplastic syndrome, kidney cancer, anemia, hypercalcemia

Abstract

Introduction: The impact of paraneoplastic syndromes (PNS) on survival in patients with renal cell carcinoma (RCC) is uncertain. This study was conducted to analyze the association of PNS with recurrence and survival of patients with non-metastatic RCC undergoing nephrectomy.

Methods: The Canadian Kidney Cancer information system is a multi-institutional cohort of patients started in January 2011. Patients with nephrectomy for non-metastatic RCC were identified. PNS included anemia, polycythemia, hypercalcemia, and weight loss. Associations between PNS and recurrence or death were assessed using Kaplan-Meier curves and multivariable analysis.

Results: Of 4337 patients, 1314 (30.3%) had evidence of one or more PNS. Patients with PNS were older, had higher comorbidity, and had more advanced clinical and pathological tumor characteristics as compared to patients without PNS (all p<0.05). Kaplan-Meier five-year estimated recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were significantly worse in patients with PNS (63.7%, 84.3%, and 79.6%, respectively, for patients with PNS vs. 73.9%, 90.8%, and 90.1%, respectively, for patients without PNS, all p<0.005). On univariable analysis, presence of PNS increased risk of recurrence (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.48–1.90, p<0.0001) and cancer-related death (HR 1.85, 95% CI 1.34–2.54, p=0.0002). Adjusting for known prognostic factors, PNS was not associated with recurrence or survival.

Conclusions: In non-metastatic RCC patients undergoing surgery, presence of PNS is associated with older age, higher Charlson comorbidity index score, advanced tumor stage, and aggressive tumor histology. Following surgery, baseline PNS is not strongly independently associated with recurrence or death.

Published
2020-09-28
How to Cite
Sun, R., Breau, R. H., Mallick, R., Tanguay, S., Pouliot, F., Kapoor, A., Lavallée, L. T., Finelli, A., So, A. I., Rendon, R. A., Fairey, A. S., Lattouf, J.-B., Kawakami, J., Bhindi, B., Basappa, N. S., Wood, L. A., Bjarnason, G. A., Heng, D. Y. C., & Bansal, R. K. (2020). Prognostic impact of paraneoplastic syndromes on patients with nonmetastatic renal cell carcinoma undergoing surgery: Results from Canadian Kidney Cancer information system. Canadian Urological Association Journal, 15(4), 132-7. https://doi.org/10.5489/cuaj.6833
Section
Original Research