Prognostic Values of Histologic Subtype and Other Clinicopathologic Features: A Study of 961 Patients with Renal Cell Carcinomas Treated by Radical Nephrectomy.
Steven S Shen, Jae Y Ro, Luan D Truong, Alberto G Ayala. The Methodist Hospital and Weill Medical College of Cornell University, Houston, TX
Background: Several clinicopathologic features have been previously shown to be important prognostic factors in renal cell carcinoma (RCC). However, there remains significant controversy on their difference in prognosis among the three most common subtypes of RCC, namely clear cell, papillary and chromophobe RCC and whether histologic subtype is an independent prognostic factor. We investigated the clinicopathologic features, in particular the histologic subtype and their prognostic significance.
Design: We retrospectively reviewed clinicopathologic features of 961 consecutive patients with RCC treated by radical nephrectomy (1990-2009). The features studied include patients' age and sex, TNM stage of tumor, tumor size, Fuhrman nuclear grade, vascular invasion, margin status, and sarcomatoid changes. Univariate and multivariate Cox regression analysis was performed to evaluate the independent significance of each variable.
Results: Of the 961 patients with RCC, 751 (78.2%), 126 (13.1%), 64 (6.7%), and 20 (2.0%) had clear cell, papillary, chromophobe, and other RCC, respectively. There were no significant differences in patients' age or tumor size among the three most common subtypes of RCC. There was a higher percentage of chromophobe RCC in female than clear cell and papillary RCC (P<0.05). There were higher percentages of local advanced stages (≥pT3) of clear cell RCC than papillary and chromphobe RCC (P<0.05). The 5-year survival rates were 62%, 52%, 86% for clear cell, papillary and chromophobe RCC, respectively. Type 1 papillary RCC has significant better survival than type 2 (63% vs. 33%). Features that were shown to be significant prognostic factors in multivariate analysis include: patients' age and sex, histologic type, TNM stage, Fuhrman nuclear grade, sarcomatoid changes, vascular invasion and positive margin.
Conclusions: In addition to patients' age, sex, TNM stage, Fuhrman nuclear grade, sarcomatoid change, vascular invasion, positive margin, histologic subtype is an independent prognostic factor in patients with RCC. As a group, papillary RCC has a worse prognosis than clear cell and chromphobe RCC, and type 2 papillary RCC has a worse prognosis than type 1 papillary RCC.
Category: Genitourinary (including renal tumors)
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 119, Wednesday Morning