Clinical Prognostic Factors and Survival Outcome in Renal Cell Carcinoma Patients - A Malaysian Single Centre Perspective

Background: This study concerns clinical characteristics and survival of renal cell carcinoma (RCC) patientsin University Malaya Medical Centre (UMMC), as well as the prognostic significance of presenting symptoms.Materials and
Methods: The clinical characteristics, presenting symptoms and survival of RCC patients(n=151) treated at UMMC from 2003-2012 were analysed. Symptoms evaluated were macrohaematuria, flankpain, palpable abdominal mass, fever, lethargy, loss of weight, anaemia, elevated ALP, hypoalbuminemia andthrombocytosis. Univariate and multivariate Cox regression analyses were performed to determine the prognosticsignificance of these presenting symptoms. Kaplan Meier and log rank tests were employed for survival analysis.
Results: The 2002 TNM staging was a prognostic factor (p<0.001) but Fuhrman grading was not significantlycorrelated with survival (p=0.088). At presentation, 76.8% of the patients were symptomatic. Generally,symptomatic tumours had a worse survival prognosis compared to asymptomatic cases (p=0.009; HR 4.74).All symptoms significantly affect disease specific survival except frank haematuria and loin pain on univariateCox regression analysis. On multivariate analysis adjusted for stage, only clinically palpable abdominal massremained statistically significant (p=0.027). The mean tumour size of palpable abdominal masses, 9.5±4.3cm,was larger than non palpable masses, 5.3±2.7cm (p<0.001).
Conclusions: This is the first report which includessurvival information of RCC patients from Malaysia. Here the TNM stage and a palpable abdominal mass wereindependent predictors for survival. Further investigations using a multicentre cohort to analyse mortality andsurvival rates may aid in improving management of these patients.