Clinicopathologic Characteristics and Outcomes of Renal Cell Carcinoma: A Single Center Experience.
Payal Kapur, Ramy Youssef, Firas Alhalabi, Vitaly Margulis, Yair Lotan, Wareef Kabbani. UT Southwestern Medical Center, Dallas, TX
Background: Renal cell carcinoma (RCC) forms 4% of all adult cancers with an increasing incidence. Although rate of metastases at presentation remains high (30%), the incidence of localized RCC has also increased. About 20%-30% of patients develop local recurrence or distant metastasis after resection. This study aimed to redefining clinicopathologic features of RCC based on a single specialized center experience.
Design: We retrospectively reviewed medical records of patients who underwent resections for RCC between 1997 and 2008 at UTSW. Clinical and pathologic data were extracted. All H&E stained slides of all available cases were reviewed.
Results: 632 resections were done; 427 (68%) were conventional (ccRCC), 79 (12.5%) papillary (pRCC), 34 (5%) chromophobe (cRCC), 49 oncocytoma (7.5%), 13 (2%) clear cell papillary renal cell carcinoma (ccPRCC), 5 (1%) acquired cystic renal disease associated renal cell carcinoma (ACDK-RCC), 12 (2%) unclassified, 3 (0.5%) cases were a translocation-associated carcinoma and one case (0.3%) of renal mucinous tubular and spindle cell carcinoma. Median age for ccRCC was 59 years (range 18-94; M:F ratio is 1.5:1). Of 421 ccRCC patients with follow-up, there were 397 (94.3%) alive, 377 (90%) had no evidence of tumor and 20 (10%) had confirmed recurrences/metastases. Twenty-four (5.7%) died within the follow-up period (mean time 4.9 years), of which, nine patients (2.1%) died of metastatic/ recurrent tumor and 15 died by other causes. On the other hand, of 77 patients with pRCC with available follow up, 5 died (Two (2.5%) died of disease), and 73 were alive at last follow-up (with 2 patients (2.5%) with recurrence/metastases). Advanced pathologic tumor stage (>=pT3) was more frequent for ccPRCC than pRCC (30% vs. 4%, p=0.0004); however, pRCC tended to demonstrate a higher Fuhrman nuclear grade (G3-4) (53% vs. 41%, p=0.07) and more frequent lymph node involvement at presentation (4% vs. 1%, p=0.06). Amongst the newly described group of RCC (ccPRCC, ACDK-RCC, translocation-associated RCC and mucinous tubular and spindle cell carcinoma), all patients were alive with no evidence of disease within the follow-up period.
Conclusions: This data is compatible with the literature incidence of RCC, yet, the frequency of recurrence and metastases following surgery is lower. In addition, while pRCC tended to show a higher nuclear grade and more frequent nodal involvement, ccRCC had a higher pathological stage at presentation and relatively worse disease-free survival.
Category: Genitourinary (including renal tumors)
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 122, Wednesday Morning