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

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.

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.

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.

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.

Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2020 Sep 28 [Epub ahead of print]

Ryan Sun, 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 Bansal

Department of Surgery, University of Manitoba, Winnipeg, MN, Canada., Division of Urology, University of Ottawa, Ottawa, ON, Canada., Division of Urology, McGill University, Montreal, QC, Canada., Division of Urology, Department of Surgery, Université Laval, Quebec City, QC, Canada., Division of Urology, McMaster Institute of Urology, Hamilton, ON, Canada., Division of Urology, University of Toronto, Toronto, ON, Canada., Department of Urologic Sciences, The University of British Columbia, Vancouver, BC, Canada., Department of Medicine and Urology, Dalhousie University, Halifax, NS, Canada., Division of Urology, University of Alberta, Edmonton, AB, Canada., Department of Surgery, Université de Montréal, Montreal, QC, Canada., Southern Alberta Institute of Urology, Calgary, AB, Canada., Department of Oncology, University of Alberta, Edmonton, AB, Canada., Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada., Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.