Elsevier

Urology

Volume 69, Issue 2, February 2007, Pages 230-235
Urology

Adult urology
Survival Analysis of 130 Patients with Papillary Renal Cell Carcinoma: Prognostic Utility of Type 1 and Type 2 Subclassification

https://doi.org/10.1016/j.urology.2006.09.052Get rights and content

Objectives

To evaluate the prognostic significance of subtyping papillary renal cell carcinoma (PRCC) into type 1 and type 2 tumors.

Methods

From 1995 to 2004, 1358 patients underwent surgery for renal cell carcinoma, of whom 130 had PRCC alone on the specimen. The tumor characteristics, including their subtype, were analyzed; small basophilic cells and large eosinophilic cells were defined type 1 and type 2 tumors, respectively. Survival analyses were performed retrospectively.

Results

Of the 130 patients (110 men and 20 women, mean age 60.6 ± 15.3 years) with PRCC, 102 underwent radical nephrectomy (78.4%) and 28 underwent partial nephrectomy (21.6%). The median tumor size was 4.5 cm (range 0.5 to 21). The comparison of the 68 (52.3%) type 1 PRCCs and 62 (47.7%) type 2 PRCCs revealed that type 2 tumors were associated with a greater stage and grade and microvascular invasion significantly (P <0.001) more often. The median follow-up was 48 months (range 2 to 111). Of the 130 patients, 22 died of cancer-specific causes, 5 (7%) with type 1 and 17 (27%) with type 2 tumors (P = 0.002). The overall and disease-free survival rate was 89% and 92% in type 1 tumors and 55% and 44% in type 2 tumors, respectively. Univariate analysis identified tumor type, stage (P <0.001), grade (P <0.001), microvascular invasion (P <0.001), an absence of foam cells (P <0.001), the presence of sarcomatoid cells (P = 0.001), and tumor necrosis (P = 0.007) as prognostic factors. Multivariate analysis retained tumor type (P = 0.034) and TNM stage (P <0.001).

Conclusions

The results of our study have shown that histologic subtyping of PRCC allows for the identification of an independent prognostic factor.

Section snippets

Patients

From January 1995 to December 2004, 133 (9.8%) of 1358 patients undergoing surgery for RCC were diagnosed with PRCC. At surgery, 3 of these 133 patients had coexisting clear cell RCC and PRCC on the specimen and were excluded from the study. The remaining 130 patients included 110 men and 20 women (mean age 60.6 ± 15.3 years, range 17.2 to 85.2). Data were obtained from the patients’ medical records. The presenting symptoms, preoperative investigation findings, pathologic features, treatment,

Results

Patient, treatment, and tumor characteristics according to pathologic tumor subtype are given in Table 1.

Comment

PRCC is a well-recognized distinct tumor type among renal tumors exhibiting a large range of morphologic variants.6, 12 We reviewed 130 cases of PRCC and stratified them as type 1 or type 2 according the histologic features and found a prognostic significance with this subdivision.

PRCCs are typically characterized by a predominant papillary pattern (50% or more of the tumor),3, 4, 12 a cytokeratin 7-positive immunophenotype,6 and recurrent cytogenetic alterations (trisomy or tetrasomy 7/17,

Conclusions

The histologic classification of renal tumors is evolving with cytogenetic and molecular data, and it appears that the papillary group is more heterogeneous than previously thought. As our results have demonstrated, the subclassification of PRCC according to Delahunt and Eble6 is of clinical relevance. The identification of type 2 PRCC may have important implications in the development of adjuvant treatment for locally advanced or poor prognosis tumors.

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