Sporadic renal cell carcinoma in young adults: presentation, treatment, and outcome.

Objectives: To present our institutional experience with young adult patients treated for sporadic renal cell cancer (RCC) during the past two decades. Sporadic RCC is rare in patients younger than 40 years old, accounting for only 3.4% of cases.

Methods: A retrospective review of 101 patients with sporadic RCC between the ages of 20 and 40 years was performed. The mean age at diagnosis was 33.7 +/- 5.5 years. Tumors were discovered incidentally in 40 patients (40%) and were symptomatic in 61 (60%). Sixteen patients (16%) had distant metastasis at diagnosis. For unilateral disease, 58 underwent radical nephrectomy and 31 nephron-sparing surgery (NSS). For bilateral RCC, 2 patients underwent bilateral radical nephrectomy, 3 underwent bilateral NSS, and 7 underwent NSS on one side and a staged contralateral radical nephrectomy. The mean postoperative follow-up was 48 +/- 44 months.

Results: The overall and cancer-specific 5-year survival rate was 61% and 67%, respectively. Tumor stage (P < 0.001) and grade (P < 0.001) had a significant impact on survival. Incidentally discovered tumors were less likely to develop metastases and had improved cancer-specific survival compared with symptomatic tumors (P = 0.001). The 5-year cancer-specific survival rate by pathologic stage was 88% for T1N0M0, 64% for T2N0M0, 61% for T3N0M0, and 0% for N+ and M+ (P < 0.001).

Conclusions: The results of our study show that RCC does not behave more aggressively in young adults younger than 40 years old than in older adults. The major determinants of patient survival are tumor stage and grade at presentation. Outcome is similar in select patients whether undergoing NSS or radical nephrectomy.