From the Guidelines
The prognosis for stage 1 Renal Cell Carcinoma (RCC) is excellent, with a 5-year cancer-specific survival rate of approximately 80-90%. At this early stage, the cancer is small and confined to the kidney, without spread to lymph nodes or distant organs. Treatment typically involves surgical removal of either the entire kidney (radical nephrectomy) or just the tumor and a small margin of surrounding tissue (partial nephrectomy), with the latter being preferred when feasible to preserve kidney function, as it results in better preservation of general kidney function and lowers the risk of developing metabolic or cardiovascular disorders 1.
Key Factors Influencing Prognosis
- The specific subtype of renal cell carcinoma
- The patient's overall health status
- Certain molecular and genetic characteristics of the tumor, such as gain of chromosomal regions 7q, 8q, and 20q, and chromosomal losses of regions 9p, 9q, and 14q, which are associated with poor survival 1
- The type of surgery performed, with partial nephrectomy being associated with lower overall survival in comparison to radical nephrectomy in some studies, but with similar cancer-specific survival and time to recurrence 1
Follow-up and Surveillance
Regular follow-up monitoring is essential, typically including imaging studies every 6-12 months for several years to check for recurrence. A risk-based approach to surveillance has been proposed, taking into account patient age, pathological stage, relapse location, and comorbidities to calculate when the risk of non-RCC death exceeds the risk of RCC recurrence 1.
Treatment Outcomes
After surgery, most patients do not require additional treatments like chemotherapy or radiation. The favorable prognosis at this stage is due to the localized nature of the disease and the effectiveness of surgical intervention in completely removing the cancer before it has a chance to spread. Factors that may influence individual prognosis include the specific subtype of renal cell carcinoma, the patient's overall health status, and certain molecular and genetic characteristics of the tumor, as well as the type of surgery performed and the presence of positive margins after partial nephrectomy 1.
From the Research
Prognosis for Stage 1 Renal Cell Carcinoma (RCC)
The prognosis for stage 1 RCC is generally good, with a high 5-year cancer-specific survival rate. According to 2, the 5-year RCC-specific survival rate for patients with stage T1a RCC is 95% to 98%. Similarly, 3 reports that for patients with renal masses less than 4 cm in size, partial nephrectomy can result in a 5-year cancer-specific survival of more than 94%.
Factors Affecting Prognosis
Several factors can affect the prognosis of patients with stage 1 RCC, including:
- Tumor size: Smaller tumors tend to have a better prognosis 4
- Tumor location: Tumors located in the center of the kidney may be more difficult to treat than those located peripherally
- Histologic type: Clear cell RCC is the most common histologic subtype and has a variable prognosis 5
- Fuhrman's nuclear grade: Higher grades are associated with a poorer prognosis 6
- Microvascular invasion: Presence of microvascular invasion is associated with a higher risk of distant metastasis 6
- Tumor necrosis: Presence of tumor necrosis is associated with a higher risk of distant metastasis 6
Treatment Options
Treatment options for stage 1 RCC include:
- Partial nephrectomy: A surgical procedure that removes the tumor while preserving the rest of the kidney 2, 3, 4
- Radical nephrectomy: A surgical procedure that removes the entire kidney 2, 3, 4
- Ablative techniques: Such as cryoablation or radiofrequency ablation, which use extreme temperatures to destroy the tumor 2, 3
- Active surveillance: For small tumors, active surveillance may be an option, which involves regularly monitoring the tumor with imaging tests 3