People with kidney cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person's medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together to arrive at a prognosis.
A prognosis is the doctor's best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic factors for kidney cancer.
Stage
Stage is the most important prognostic factor for kidney cancer. The less advanced a kidney tumour is at diagnosis, the more favourable the prognosis.
- Tumours confined to the kidney have a better prognosis than tumours that have spread outside the kidney.
- Kidney tumours that invade the vena cava (the large vein in the abdomen leading to the heart) have a poor prognosis.
Grade
Tumours that are lower grade are slow-growing and are less likely to spread. High-grade tumours are more aggressive and tend to spread quickly.
Type of tumour
The type of renal cell carcinoma may have an effect on prognosis.
- Papillary and chromophobe types of renal cell carcinoma have a better prognosis because these tumours often are low grade.
- Collecting duct carcinoma and renal cell sarcoma have a poor prognosis because these tumours are very aggressive.
Genetic forms of kidney cancer
People with genetic conditions that increase the risk of developing kidney cancer have a poor prognosis.
- With certain genetic conditions, tumours may occur in both kidneys, at a younger age and are often more aggressive types of renal cell carcinoma.
- Tumours often recur after treatment.
Other prognostic factors
Other specific factors that may play a role in the prognosis of kidney cancer are:
- lactose dehydrogenase (LDH) level
- People who have an LDH level more than 1.5 times higher than normal have a less favourable prognosis.
- blood calcium level
- Elevated blood calcium indicates a poor prognosis.
- low red blood cell count (anemia)
- People who have anemia at diagnosis have a less favourable prognosis.
- performance status
- People with a poor performance status at diagnosis have a less favourable outcome.
If a person with kidney cancer has 3 or more of these specific factors at diagnosis, they have a less favourable prognosis.
Metastatic kidney cancer
The prognostic factors for metastatic kidney cancer (that has spread to other parts of the body) are:
- location of metastases
- Lung metastases have a better prognosis than bone or brain metastases.
- number of metastatic sites
- People who have a single metastatic tumour have a better prognosis than people who have multiple metastases.
- length of time between treatment and development of metastases
- People who develop metastases a year or more after first being treated for kidney cancer have a better prognosis than people who develop metastases sooner.
- weight loss
- People who have lost weight have a less favourable outcome.
- performance status
- People with a poor performance status have a less favourable outcome.