Renal cell carcinoma (RCC) accounts for nearly 90% of all primary renal malignancies and remains a major cause of cancer-related mortality worldwide. The increasing use of abdominal imaging has led to earlier diagnosis; however, a significant proportion of patients continue to present with locally advanced or metastatic disease.¹

Several clinicopathological variables including pathological stage, nuclear grade, histological subtype, lymph node involvement, and vascular invasion have been shown to influence prognosis.²⁻⁵ Pathological stage remains the most important determinant of survival following surgical treatment.⁴˒⁵

Although established prognostic indicators provide valuable information, many become available only after surgical excision and histopathological assessment. Identification of readily available preoperative markers capable of predicting aggressive disease remains an area of ongoing interest. Renal function parameters such as serum creatinine may provide additional prognostic information and aid in risk stratification.¹¹

The present study aimed to evaluate the clinicopathological profile of RCC patients managed surgically at a tertiary care centre and identify factors associated with mortality.

Study Design: Retrospective observational case series. Study Setting: Department of Urology, Institute of Nephro-Urology, Bangalore. Study Population: Eighteen patients with histopathologically confirmed RCC who underwent surgical management during the study period. Inclusion Criteria: • Histopathologically confirmed RCC. • Patients undergoing radical or partial nephrectomy. • Availability of complete clinical and pathological records. Exclusion Criteria: • Incomplete records. • Non-RCC renal malignancies. Data Collection: Demographic, clinical, laboratory, radiological, pathological, and survival-related variables were collected from institutional records. Statistical Analysis: Continuous variables were expressed as mean and range. Categorical variables were expressed as frequencies and percentages. Fisher's exact test and Mann–Whitney U test were used where appropriate. A p-value <0.05 was considered statistically significant.

A total of 18 patients were included. The cohort demonstrated a male predominance with a male-to-female ratio of approximately 1.6:1(Table 1). The cohort demonstrated a male predominance with a male-to-female ratio of approximately 1.6:1. Clear-cell RCC represented the predominant histological subtype (Table 2).

Table 1: Demographic Characteristics

Table 2: Histological Distribution

Advanced pathological stage demonstrated a statistically significant association with mortality. No deaths were observed among patients with organ-confined disease, whereas all mortality events occurred among patients with T3–T4 tumours. Higher Fuhrman grades and lymph node positivity demonstrated higher mortality rates, although statistical significance was not achieved (Table 3). Patients with advanced-stage disease and patients who died during follow-up demonstrated significantly higher baseline serum creatinine levels (Table 4).No significant associations were identified between mortality and age, haemoglobin, blood urea, neutrophil-to-lymphocyte ratio, platelet count, or total leukocyte count.

Table 3: Association of Prognostic Variables with Mortality

Table 4: Serum Creatinine and Outcome Analysis

The present study evaluated the clinicopathological characteristics and prognostic factors associated with mortality among patients with RCC managed surgically at a tertiary care centre. The demographic profile observed in this cohort is comparable to previous studies, with RCC predominantly affecting males in the sixth decade of life.¹˒² Clear-cell RCC accounted for nearly four-fifths of all tumours, consistent with global epidemiological data.¹˒⁶ Advanced pathological stage emerged as the strongest predictor of mortality. All deaths occurred among patients with T3–T4 disease, emphasizing the prognostic importance of pathological staging. Similar findings have been consistently reported in previous studies and prognostic models.⁴˒⁵˒⁹ A notable finding of this study was the significant association between elevated baseline serum creatinine and both advanced pathological stage and mortality. Patients with advanced disease demonstrated significantly higher creatinine levels than those with organ-confined tumours, while non-survivors exhibited significantly higher baseline creatinine levels than survivors. Serum creatinine is routinely available during preoperative evaluation and may serve as a simple marker of aggressive disease biology. Previous studies have suggested that impaired renal function may reflect reduced functional renal parenchyma, increased tumour burden, and diminished physiological reserve.¹¹ Higher Fuhrman grade and lymph node positivity were associated with increased mortality. Although statistical significance was not achieved, likely due to the limited sample size, the observed trends are consistent with established literature demonstrating the adverse prognostic significance of high nuclear grade and nodal involvement.⁷˒⁸ Interestingly, commonly investigated haematological markers including haemoglobin, total leukocyte count, platelet count, and neutrophil-to-lymphocyte ratio did not demonstrate significant associations with mortality in this cohort. Limitations: The study is limited by its retrospective design, small sample size, single-centre setting with limited follow-up. Larger multicentre studies are required to validate these findings.

Advanced pathological stage was significantly associated with mortality in patients with RCC. Elevated preoperative serum creatinine demonstrated significant associations with both advanced-stage disease and mortality, suggesting its potential utility as a readily available prognostic marker. Higher Fuhrman grade and lymph node positivity exhibited adverse prognostic trends. Further studies involving larger cohorts are warranted to validate these findings.

ETHICS STATEMENT

This retrospective study was conducted using anonymised patient data obtained from institutional records. Institutional approval was obtained as per departmental protocol.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

FUNDING

No external funding was received for this study.

1. Capitanio U, Bensalah K, Bex A, et al. Epidemiology of renal cell carcinoma. Eur Urol. 2019;75(1):74-84.
2. Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology Guidelines on Renal Cell Carcinoma. Eur Urol. 2024.
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Kidney Cancer. Version 2025.
4. Leibovich BC, Blute ML, Cheville JC, et al. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma. Cancer. 2003;97(7):1663-1671.
5. Zisman A, Pantuck AJ, Dorey F, et al. Improved prognostication of renal cell carcinoma using integrated staging systems. J Clin Oncol. 2001;19(6):1649-1657.
6. Delahunt B, Cheville JC. Renal cell carcinoma classification and grading. Pathology. 2021;53(1):3-17.
7. Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982;6(7):655-663.
8. Ficarra V, Novara G, Iafrate M, et al. Prognostic role of lymph node involvement in renal cell carcinoma. Eur Urol. 2009;55(2):261-275.
9. Patard JJ, Leray E, Rioux-Leclercq N, et al. Correlation of tumor stage and survival in renal cell carcinoma. J Clin Oncol. 2005;23(12):2763-2771.
10. Campbell SC, Uzzo RG, Karam JA, et al. Renal Mass and Localized Renal Cancer: Evaluation, Management and Follow-up. J Urol. 2021;206(2):199-208.
11. Lane BR, Campbell SC, Demirjian S, et al. Chronic kidney disease after nephrectomy and implications for renal cancer outcomes. Urology. 2011;77(4):803-809.