Factors associated with the survival of patients with primary small cell carcinoma of the kidney

Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Gueishan, Taoyuan, Taiwan.
International Journal of Clinical Oncology (Impact Factor: 2.13). 12/2011; 18(1). DOI: 10.1007/s10147-011-0355-7
Source: PubMed


Primary small cell carcinoma (SCC) of the kidney is rare, and the factors associated with the survival of these patients are yet to be elucidated.
Patients and methods
We collected data on patients who were admitted to our hospital for SCC of the kidney in the last 22 years and of those in studies in the literature. Clinical characteristics were summarized using descriptive statistics. The associations of these factors with survival were evaluated using Cox regression models, and the hazard ratio of death was calculated.
This study included 45 patients (8 admitted to our hospital and 37 from studies in the literature) with SCC of the kidney. The overall median survival time was 9.9 months (range 6.9–31.6). Data on demographics, clinical symptoms, tumor staging, and tumor characteristics recorded at the time of diagnosis were not associated with survival. Among the different treatment modalities applied, cisplatin-based chemotherapy afforded a strong survival advantage (hazard ratio = 0.35, p = 0.022). However, patients with early local recurrence (hazard ratio = 19.13, p = 0.012) and early distant metastasis (hazard ratio = 10.93, p = 0.003) after primary treatment showed significantly poor survival.
Patients with primary SCC of the kidney generally presented with large, advanced-stage tumors and showed poor survival. Early detection of the tumor, use of cisplatin-based chemotherapy, and careful follow-up for local recurrence or frequent metastasis within 6 months after the primary treatment could be important for improving overall patient survival.

Download full-text


Available from: Yung-Chang Chen, Apr 22, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Primary small cell carcinoma of the kidney is an extremely rare neoplasm. Less than 100 cases of primary small cell carcinoma of the kidney have so far been reported in the literature. In view of this most practitioners globally would not be accustomed to the biological behaviour of this neoplasm. There is therefore the need to review the literature on primary small cell carcinoma of the kidney. To review the literature on primary small cell carcinoma of the kidney, various internet search engines were used to form a foundation for the literature review including: Google; Google scholar; educus; Up To Date; Pub Med. The median age at diagnosis of small cell carcinoma of the kidney was 62 years and there was a female preponderance. Abdominal pain and haematuria are common symptoms of small cell carcinoma of the kidney. At the time of initial diagnosis slightly less than a third of the patients have distant metastasis. Surgery in the form of nephrectomy and systemic chemotherapy, have been the main forms of treatment modalities which include: nephrectomy alone; nephrectomy and chemotherapy; chemotherapy alone. The median survival in one series was about 8 months and this has ranged on the whole from between 1 month to 101 months. In another series the overall median survival was 9.9 months (range 6.9 to 31.6 months). Data on demographics, clinical symptoms, tumour staging and tumour characteristics recorded at the time of diagnosis was not found to be related to survival. The use of cisplatin-based chemotherapy was in some cases observed to be predictive of better overall survival. Small cell carcinoma of the kidney is an extremely rare neoplasm which mimics small cell carcinoma of the tracheobronchial tree and other extra-pulmonary sites, its aggressive biological behaviour and its high ability to result in the development of loco-regional and distant dissemination. The development of symptoms or clinical presentation tends to be usually late in the course of the disease. Utilization of platinum-based chemotherapeutic regimen has been found to be associated with tumour regression and prolonged survival. Small cell carcinomas of the genitourinary tract have been more commonly reported in the urinary bladder in comparison with primary small cell carcinoma of the kidney which is very rare. In view of the rarity of primary small cell carcinoma of the kidney its natural history, diagnosis and management is not well known. Despite the use of cisplatin-based chemotherapeutic regimen in the treatment of small cell carcinoma of the kidney there is not enough documentation of any treatment modality that would prolong life for a very long time. There is therefore the need for Urologists and oncologists throughout the world to come together in order to undertake a multicentre trial of chemotherapeutic modalities in the management of small cell carcinoma of the kidney in order to find ways of further improving the prognosis of such a rare carcinoma.. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
    No preview · Dataset · May 2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Extrapulmonary small cell carcinoma (EPSCC) is a rare neoplasm comprising 2.5% to 5% of small cell carcinomas (SCCs). Bladder SCC is the most common site of genitourinary tract. Primary renal SCC is extremely rare. We report a case of primary SCC of the kidney which is rarely reported in the urinary tract and presents an aggressive clinical picture. A 59-year-old female visited a urologic clinic with complaint of persistent left flank soreness 10 years after undergoing renal transplantation. Abdominal computed tomography showed a left renal pelvis tumor. After the patient received left nephroureterectomy with bladder cuff resection, her pathology results showed SCC. After surgery, she received adjuvant systemic chemotherapy, and her recovery has been uneventful as of 8 months. Primary renal SCC presents with an advanced tumor stage and a short median survival period, therefore early intervention and close follow-up are recommended.
    No preview · Article · Oct 2013 · Chinese Journal of Cancer Research
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Though extrapulmonary small cell carcinoma was first described over 80 years ago, definitive treatment recommendations are lacking. The treatment strategies commonly utilized are extrapolated from pulmonary small cell carcinoma experience. A better understanding of this entity is needed to improve management approach. The University of Kansas tumor registry was reviewed from 1990 to 2013. Thirty-five cases met the inclusion and exclusion criteria for review. Age, gender, smoking status, weight loss, metastatic disease-related data, stage, performance status (PS), treatment received, and survival data were collected. Patients were evaluated with a variety of primary locations of disease including GI tract (29 %), GU tract (35 %), Gyn organs (17 %), head and neck (14 %), and unknown primary (9 %). Several sites of metastatic disease were noted, with 57 and 43 % of patients meeting criteria for limited disease (LD) and extensive disease (ED), respectively. Chemotherapy, surgery, and radiation were used in several different regimens, with small cell lung cancer-type regimens incorporating a platinum and etoposide being the most common (74 %). Patients with LD had a median survival of 36 months compared with 5 months in patients with ED (p < 0.0001). Among different primary sites, patients with GU and Gyn LD tumors had best median survival of 36 months. Among other variables that were examined with respect to their poor prognostic significance, PS >2 (p = 0.001) and one or fewer number of treatment modalities especially in LD (p = 0.0005) were found to be associated significantly with mortality. GI and GU tract tumors were the most common primary sites of disease in our retrospective review. Survival varied according to stage, PS, site of primary disease, use of chemotherapy, and number of treatment modalities used. Further studies are needed to better understand this rare disorder and optimize management approach.
    Full-text · Article · Oct 2014 · Medical Oncology
Show more