Gender as a prognostic factor in patients with renal cell carcinoma.

OBJECTIVE: To evaluate gender as a prognostic factor in patients with renal cell carcinoma (RCC), using a retrospective review of patients with RCC stratified according to gender and analysing factors affecting prognosis.

PATIENTS AND METHODS: From January 1957 to December 1995, 768 patients with pathologically defined RCC (all of whom underwent nephrectomy) were classified as having clear cell carcinoma in 662 (follow-up in 648), papillary RCC in 43 (follow-up in 42), chromophobe cell carcinoma in 36 (follow-up in 34) and cyst-associated RCC in 27 (all followed up) according to the criteria proposed by the World Health Organization. The survival rates were compared between men and women, calculated and stratified according to the subtype of RCC.

RESULTS: There tended to be a more favourable prognosis in women than in men but the difference was not quite significant (P=0.061). Of those with clear cell carcinoma, women had a more favourable prognosis than men and the difference in survival was significant (P=0.012). No other subtype of RCC was associated with a significant difference in survival between the sexes. There was a smaller proportion of patients with stage IV and a larger proportion with stage I disease in women than in men (P<0.05). Of stage I patients, women had a more favourable prognosis than men (P<0.011). Women had better survival after recurrence than had men, the difference being significant (P=0.007).

CONCLUSION: The prognosis is significantly better in women than men with clear cell carcinoma. The factors that contribute to a favourable prognosis in women are the greater proportion of lower stage disease and better survival after recurrence.