Clinicopathological features and prognosis of synchronous bilateral renal cell carcinoma: an international multicentre experience

Tobias Klatte, Heiko Wunderlich, Jean-Jacques Patard, Mark D Kleid, John S Lam, Kerstin Junker, Jörg Schubert, Malte Böhm, Ernst P Allhoff, Fairooz F Kabbinavar, Maxime Crepel, Luca Cindolo, Alexandre De La Taille, Jacques Tostain, Arnaud Mejean, Michel Soulie, Laurent Bellec, Jean Christophe Bernhard, Jean-Marie Ferriere, Christian Pfister, Baptiste Albouy, Marc Colombel, Amnon Zisman, Arie S Belldegrun, Allan J Pantuck
BJU International 2007, 100 (1): 21-5

OBJECTIVE: To present a multicentre experience and the largest cohort to date of nonmetastatic (N0M0) synchronous bilateral renal cell carcinoma (RCC), as because it is rare the single-institutional experience is limited.

PATIENTS AND METHODS: We retrospectively studied 10 337 patients from 12 urological centres to identify patients with N0M0 synchronous bilateral RCC; the clinicopathological features and cancer-specific survival were compared to a cohort treated for N0M0 unilateral RCC.

RESULTS: In all, 153 patients had synchronous bilateral solid renal tumours, of whom 135 (88%) had synchronous bilateral RCC, 118 with nonmetastatic disease; 91% had nonfamilial bilateral RCC. Bilateral clear cell RCC was the major histological subtype (76%), and papillary RCC was the next most frequent (19%). Multifocality was found in 54% of bilateral RCCs. Compared with unilateral RCC, patients did not differ in Eastern Cooperative Oncology Group performance status (ECOG PS) and T classification, but bilateral RCCs were more frequently multifocal (54% vs 16%, P < 0.001) and of the papillary subtype (19% vs 12%), and less frequently clear cell RCC (76% vs 83%, P = 0.005). For the outcome, patients with nonmetastatic synchronous bilateral RCC and unilateral RCC had a similar prognosis (P = 0.63); multifocality did not affect survival (P = 0.60). Multivariate analysis identified ECOG PS, T classification, and Fuhrman grade, but not laterality, as independent prognostic factors for cancer-specific survival.

CONCLUSIONS: Patients with N0M0 synchronous bilateral RCC and N0M0 unilateral RCC have a similar prognosis. The frequency of a familial history for RCC (von Hippel-Lindau disease or familial RCC) was significantly greater in bilateral synchronous than in unilateral RCC. The significant pathological findings in synchronous bilateral RCC are papillary subtype and multifocality.

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