Originally published as JCO Early Release 10.1200/JCO.2008.20.6524 on July 13 2009

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Risk of Bilateral Renal Cell Cancer

From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Cancer Registry of Norway, Oslo, Norway; Dana-Farber Cancer Institute and Dana-Farber/Harvard Cancer Center; and Department of Epidemiology, Harvard School of Public Health, Boston, MA.

Corresponding author: Hans-Olov Adami, MD, PhD, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115; e-mail: adami{at}hsph.harvard.edu.

Purpose The risk of developing bilateral kidney cancer has not been adequately defined in any large, population-based study with long-term follow-up to our knowledge.

Patients and Methods We estimated the risk of metachronous bilateral renal cell cancer in patients diagnosed with unilateral kidney cancer, as recorded in the nationwide cancer registries of Norway and Sweden. Altogether 28,642 patients were followed for an average of 4.4 years. The standardized incidence ratio—the ratio of the observed number of bilateral cancers to the number expected on the basis of the incidence in the Norwegian and Swedish population at large—was used as a measure of relative risk. We used multivariate Poisson regression to separate the effects of the explanatory variables.

Results A synchronous bilateral renal cell cancer was reported in 86 patients. A total of 112 metachronous bilateral cancers were recorded during 126,493 person-years of follow-up compared with 35.8 expected, yielding an overall relative risk (RR) of 3.1 (95% CI, 2.6 to 3.8) and a cumulative incidence of 0.8% after 20 or more years of follow-up. In the multivariate analyses, risk increased monotonically with younger age at first diagnosis (P for trend < .001); compared with patients who were 60 years or older, those younger than 40 years were at a 17-fold higher risk (RR = 17.4; 95% CI, 10.1 to 29.8). We also found a modest but statistically significant decreasing trend with increasing duration of follow-up.

Conclusion The risk of metachronous bilateral renal cell cancer is drastically higher among patients first affected at a young age, suggesting a subset of early onset renal cell cancer with a strong genetic component.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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