Histological subtype of renal cell carcinoma significantly affects survival in the era of partial nephrectomy

To analyze whether the histological subtype of renal cell carcinoma (RCC) affects survival after surgical resection in contemporary patients, and if so, whether prognostic significance differs according to the type of surgical resection or tumor stage. From 2006 to 2014, 2,237 patients underwent sur...

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Vydáno v:Urologic oncology Ročník 34; číslo 6; s. 259.e1 - 259.e8
Hlavní autoři: Nguyen, Daniel P., Vertosick, Emily A., Corradi, Renato B., Vilaseca, Antoni, Benfante, Nicole E., Touijer, Karim A., Sjoberg, Daniel D., Russo, Paul
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Elsevier Inc 01.06.2016
Témata:
Aged
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - surgery
Disease-Free Survival
Female
Histological subtype
Humans
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Nephrectomy - methods
Prognosis
Recurrence
Renal cell carcinoma
Survival
Survival Rate
Urology
Recurrence
Histological subtype
Renal cell carcinoma
Survival
ISSN:1078-1439, 1873-2496, 1873-2496
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Shrnutí:To analyze whether the histological subtype of renal cell carcinoma (RCC) affects survival after surgical resection in contemporary patients, and if so, whether prognostic significance differs according to the type of surgical resection or tumor stage. From 2006 to 2014, 2,237 patients underwent surgical resection (25% radical nephrectomy and 75% partial nephrectomy [PN]) for nonmetastatic RCC at a tertiary referral center. Estimated survival function curves and Cox regression models evaluated the effect of histological subtype on recurrence-free survival (RFS) and overall survival (OS). Interaction analyses tested whether the effect of histological subtype depends on the type of surgical resection or tumor stage. Patients with RCC stage T2 or lower and those with low-grade conventional clear cell, papillary or chromophobe RCC of any stage had 5-year RFS probabilities>90%. Patients with clear cell papillary RCC stage T3 or greater had predicted 5-year RFS of 81%. However, 5-year OS probabilities were>94% for clear cell papillary RCC of any stage. High-grade conventional clear cell and papillary RCC stage T2 or lower, low-grade conventional clear cell and chromophobe RCC of any stage conferred 5-year OS probabilities of >93%. Unclassified RCC demonstrated the lowest OS probabilities at any stage. In multivariable analyses, histological subtype affected RFS (P<0.0001) and OS (P = 0.026) following surgical resection, with no differences in this association for radical nephrectomy vs. PN (RFS, P = 0.2; OS, P = 0.4), and across pathologic stages (RFS, P = 0.1; OS, P = 0.3). Compared with low-grade conventional clear cell RCC, chromophobe (hazard ratio [HR] = 0.72, 95% CI: 0.30–1.75) and papillary RCC (HR = 0.30, 95% CI: 0.09–0.97) conferred lower risk of recurrence. Chromophobe (HR = 0.67, 95% CI: 0.30–1.52) and clear cell papillary RCC (HR = 0.91, 95% CI: 0.12–6.78) conferred the lowest risk of all-cause mortality. In the era of PN for RCC, histological subtype remained a significant predictor of survival, regardless of type of surgical resection or tumor stage. •The histological subtype of renal cell carcinoma remains a predictor of survival.•The predictive value of histological subtype is independent of the surgical technique.•The predictive value of histological subtype is independent of the pathologic stage.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1078-1439
1873-2496
1873-2496
DOI:10.1016/j.urolonc.2016.01.005