The Distribution of Metastatic Renal Cell Carcinoma by Presenting Tumor Stage in the Modern Era

Published:March 03, 2022DOI:


      • Migration of metastatic renal cell carcinoma in recent years to lower cT stage.
      • Higher cT stage is associated with worsened survival in the metastatic setting.
      • Possible increase in smaller renal masses with metastatic potential.



      There is a stage migration for detection of kidney cancer, thus we aim to evaluate the distribution of metastatic renal cell carcinoma by presenting clinical T stage over time.

      Materials and Methods

      The National Cancer Database was evaluated for patients with metastatic kidney cancer from 2010 to 2016. The primary outcome was the temporal trend of presenting clinical T stage over time. The secondary outcome was overall survival. Kaplan-Meier and Cox regression analyses were performed.


      The incidence of metastatic kidney cancer has increased, from 3426 new cases in 2010 to 4510 in 2016. While diagnosis of metastasis has increased for all tumor stages over time, there has been a more rapid increase in metastasis of localized renal masses (cT1-T2) as compared to locally advanced disease (cT3-T4). In 2010, 46% of the new metastatic cases diagnosed were cT3-T4, while in 2016 this proportion decreased to 38.2%. Conversely, metastatic cases with cT1-T2 tumors increased from 54% in 2010 to 61.9% in 2016. Cox regression noted an increased risk of death correlating with higher clinical T stage. On Kaplan Meier analysis, the 2-year survival was 29.3%, 30.3%, 28.3%, and 16.0% for cT1, cT2, cT3, and cT4, respectively (logrank P < .001).


      Metastatic kidney cancer is increasingly diagnosed at a lower presenting cT stage. Survival outcomes worsen with increasing cT stage in the setting of metastasis.


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        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics.
        CA Cancer J Clin. 2018; 68: 7-30
        • Chow W
        • Devesa SS
        • Warren JL
        • Fraumeni Jr JF
        Rising incidence of renal cell cancer in the United States.
        JAMA. 1999; 281: 1628-1631
        • Kane C.J.
        • Mallin K.
        • Ritchey J.
        • Cooperberg M.R.
        • Carroll P.R.
        Renal cell cancer stage migration.
        Cancer. 2008; 113: 78-83
        • Patel HD
        • Gupta M
        • Joice GA
        • et al.
        Clinical stage migration and survival for renal cell carcinoma in the United States.
        Eur Urol Oncol. 2019; 2: 343-348
        • Graves A.
        • Hessamodini H.
        • Wong G.
        • Lim W.H.
        Metastatic renal cell carcinoma: update on epidemiology, genetics, and therapeutic modalities.
        Immuno Targets Ther. 2013; 2: 73-90
        • Volpe A.
        • Patard J.J.
        Prognostic factors in renal cell carcinoma.
        World J Urol. 2010; 28: 319
        • Mekhail T.M.
        • Abou-Jawde R.M.
        • Boumerhi G.
        • et al.
        Validation and extension of the memorial sloan-kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma.
        J Clin Oncol. 2005; 23: 832-841
        • Heng D.Y.
        • Xie W.
        • Regan M.M.
        • et al.
        External validation and comparison with other models of the international metastatic renal-cell carcinoma database consortium prognostic model: a population-based study.
        Lancet Oncol. 2013; 14: 141-148
        • Bilimoria K.Y.
        • Stewart A.K.
        • Winchester D.P.
        • Ko C.Y.
        The national cancer data base: a powerful initiative to improve cancer care in the United States.
        Ann Surg Oncol. 2008; 15: 683-690
        • Smith-Bindman R
        • Kwan ML
        • Marlow EC
        • et al.
        Trends in use of medical imaging in US health care systems and in Ontario, Canada, 2000-2016.
        JAMA. 2019; 322: 843-856
        • Umbreit E.C.
        • Shimko M.S.
        • Childs M.A.
        • et al.
        Metastatic potential of a renal mass according to original tumour size at presentation.
        BJU Int. 2012; 109: 190-194
        • Thompson RH
        • Hill JR
        • Babayev Y
        • et al.
        Metastatic renal cell carcinoma risk according to tumor size.
        J Urol. 2009; 182: 41-45
        • Tsimafeyeu I.
        • Zolotareva T.
        • Varlamov S.
        • et al.
        Five-year survival of patients with metastatic renal cell carcinoma in the Russian federation: results from the RENSUR5 registry.
        Clin Genitourin Cancer. 2017; 15: e1069-e1072
        • Howlader N
        • Noone AM
        • Krapcho M
        • et al.
        SEER Cancer Statistics Review, 1975-2016.
        National Cancer Institute. Bethesda, MD, 2018 (Accessed from: [Accessed 8 Feb 2022])
        • Marchioni M.
        • Bandini M.
        • Pompe R.S.
        • et al.
        Int Urol Nephrol. 2017; 49: 2143
        • Rodriguez-Vida A
        • Hutson TE
        • Bellmunt J
        • et al.
        New treatment options for metastatic renal cell carcinoma.
        ESMO Open. 2017; 2e000185