What is the prognosis for renal cancer?

Prognosis of Renal Cell Carcinoma

The prognosis for renal cancer varies significantly by stage, with a 5-year survival rate of approximately 92.5% for localized disease compared to only 12% for metastatic disease at diagnosis. 1

Prognostic Factors by Stage

Localized Disease (Stage I/II)

• Stage I: 5-year survival rate of approximately 77.8% 2
• Stage II: 5-year survival rate of approximately 72.8% 2
• Patients with tumors confined within the renal capsule have the best prognosis
• Tumor size is a significant prognostic factor:
  • Tumors <4 cm: 5-year cancer-specific survival >94% 3
  • Tumors <5 cm: Better overall prognosis 4

Locally Advanced Disease (Stage III)

• 5-year survival rate of approximately 55.0% 2
• Invasion into perirenal fat reduces 5-year survival to 67% 4
• Renal vein invasion alone has minimal impact on 5-year survival (84%) but reduces 10-year survival to 45% 4

Metastatic Disease (Stage IV)

• 5-year survival rate of approximately 16.9% 2
• Historically poor prognosis, but improving with newer treatments
• Median overall survival with current immunotherapy combinations ranges from 46-56 months 3

Risk Stratification for Metastatic Disease

The MSKCC (Memorial Sloan Kettering Cancer Center) and IMDC (International Metastatic RCC Database Consortium) risk models are used to stratify patients with metastatic RCC 1:

MSKCC Risk Factors:

1. Karnofsky performance status <80%
2. Time from diagnosis to treatment <1 year
3. Hemoglobin < lower limit of normal
4. Corrected calcium > upper limit of normal
5. LDH > 1.5 times upper limit of normal

Risk Categories and Outcomes:

• Favorable risk (no risk factors): Median survival ~30 months 1
• Intermediate risk (1-2 risk factors): Median survival ~14 months 1
• Poor risk (≥3 risk factors): Median survival ~6 months 1

Prognostic Impact of Histology

• Clear cell RCC (70% of cases): Most common subtype 1
• Non-clear cell subtypes (papillary, chromophobe, collecting duct, etc.): Generally have different treatment approaches and variable prognosis
• Sarcomatoid differentiation: Indicates aggressive disease course regardless of histologic subtype 1
• Fuhrman nuclear grade: Significant prognostic factor in clear cell RCC 1
  • Grade 1: 77.8% 5-year survival
  • Grade 2: 69.6% 5-year survival
  • Grade 3: 48.8% 5-year survival
  • Grade 4: 35.3% 5-year survival 2

Trends in Diagnosis and Survival

• Incidence of RCC has been relatively stable in recent years 1
• Death rates have been declining on average 0.9% each year from 2007-2016 1
• Approximately 75% of people with kidney cancer survive ≥5 years after diagnosis 1
• Stage migration toward early-stage disease has stabilized at around 70% of cases presenting as Stage I 5
• Improved survival in recent years is attributed more to better treatments than to stage migration 5

Impact of Detection Method

• Incidentally discovered RCC (found during imaging for other reasons):

  • More likely to be lower stage and grade
  • 5-year cancer-specific survival rate of 85.3% 6
  • 62.1% are Stage I at diagnosis 6

• Symptomatic RCC:

  • More likely to be higher stage and grade
  • 5-year cancer-specific survival rate of 62.5% 6
  • Only 23% are Stage I at diagnosis 6

Demographic Factors

• Males have slightly worse prognosis than females (5-year survival: 62.9% vs 68.1%) 2
• Age impacts survival (5-year survival: 81.0% for <40 years vs 64.2% for >40 years) 2

Treatment Impact on Prognosis

For metastatic disease, significant advances in systemic therapy have improved outcomes:

• Immune checkpoint inhibitors and tyrosine kinase inhibitors have shown tumor response rates of 42-71% 3
• Combination therapies have demonstrated improved survival compared to single-agent approaches 1

The prognosis of renal cancer has improved over time due to earlier detection and advances in treatment, particularly for advanced disease. However, stage at diagnosis remains the most significant prognostic factor.