Growth Pattern: A New Prognostic Parameter of Clear Renal Cell Carcinoma.
Toyonori Tsuzuki, Akitoshi Fukatsu, Naoto Sassa, Toshinori Nishikimi, Satoru Katsuno, Takashi Fujita, Yasushi Yoshino, Ryohei Hattori, Momokazu Gotoh. Nagoya Daini Red Cross Hospital, Japan; Komaki City Hospital, Japan; Nagoya University Hospital, Japan; Okazaki Municipal Hospital, Japan; Chukyo Hospital, Nagoya, Japan
Background: Pathological tumor stage (pT), Fuhrman nuclear grade (FNG), lymph-vascular invasion (LVI) is thought to be useful prognostic parameter in clear cell renal cell carcinoma (CCRCC). Recently, we reported growth pattern could be a new prognostic parameter in pT1a CRCC. Herein, we assess the validity of growth pattern in CCRCC.
Design: In total, 501 patients with CCRCC without preoperative metastasis at five participating institutions were studied. Various clinicopathological parameters were analyzed in 293 patients with CCRCC without pre-operative metastasis to predict the disease-free survival rate (DFS) and the cancer-specific survival rate (CSS). Clinicopathological parameters included patient age, tumor size, pT, FNG, presence of capsule, presence of scarring, presence of hemorrhage, presence of necrosis, presence of LVI, and growth pattern (expansive or infiltrating). The expansive pattern was defined as when the tumor margin was well-circumscribed without the presence of normal renal tissue in the tumors. The infiltrative pattern was defined as when the tumor margin was ill circumscribed, and cancer cells were extensively infiltrating normal renal tissues. The infiltrative pattern was also defined as the presence of normal renal tissues in the tumors, regardless of tumor circumscription.
Results: Male to female ratio was 3.6. Patient's age ranged from 21 to 85 years (mean 60.1 years). Follow up duration ranged from one to 246 months (median 55.7 months). 59 patients showed distant metastasis. 35 patients were died with the disease. In the univariable analysis, Fuhrman grade (grade 1+2+3 vs. 4), LVI, growth pattern, and necrosis were parameters associated with a worse prognosis (p<.0001) in both the DFS and CSS. In the multivariate analysis, FNG (grade 1+2+3 vs. 4) (p=0.0185), necrosis (p=0.0044), and growth pattern (p=0.0125) were statistical significant in DFS. FNG (grade 1+2+3 vs. 4) (p=0.0010) and growth pattern (p=0.0055) were statistical significant in CSS.
Conclusions: In this study FNG and growth pattern were independent prognostic parameters in CCRCC. Growth pattern, a previously unrecognized parameter for prognosis, can be considered a new prognostic parameter in CCRCC.
Category: Genitourinary (including renal tumors)
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 124, Wednesday Morning