TY - JOUR
T1 - Impact of histologic subtype on cancer-specific survival in patients with renal cell carcinoma and tumor thrombus
AU - Tilki, Derya
AU - Nguyen, Hao G.
AU - Dall'Era, Marc A.
AU - Bertini, Roberto
AU - Carballido, Joaquín A.
AU - Chromecki, Thomas
AU - Ciancio, Gaetano
AU - Daneshmand, Siamak
AU - Gontero, Paolo
AU - Gonzalez, Javier
AU - Haferkamp, Axel
AU - Hohenfellner, Markus
AU - Huang, William C.
AU - Koppie, Theresa M.
AU - Lorentz, C. Adam
AU - Mandel, Philipp
AU - Martinez-Salamanca, Juan I.
AU - Master, Viraj A.
AU - Matloob, Rayan
AU - McKiernan, James M.
AU - Mlynarczyk, Carrie M.
AU - Montorsi, Francesco
AU - Novara, Giacomo
AU - Pahernik, Sascha
AU - Palou, Juan
AU - Pruthi, Raj S.
AU - Ramaswamy, Krishna
AU - Rodriguez Faba, Oscar
AU - Russo, Paul
AU - Shariat, Shahrokh F.
AU - Spahn, Martin
AU - Terrone, Carlo
AU - Vergho, Daniel
AU - Wallen, Eric M.
AU - Xylinas, Evanguelos
AU - Zigeuner, Richard
AU - Libertino, John A.
AU - Evans, Christopher P.
PY - 2014/9
Y1 - 2014/9
N2 - Background Although different prognostic factors for patients with renal cell carcinoma (RCC) and vena cava tumor thrombus (TT) have been studied, the prognostic value of histologic subtype in these patients remains unclear. Objective We analyzed the impact of histologic subtype on cancer-specific survival (CSS). Design, settings, and participants We retrospectively analyzed the records of 1774 patients with RCC and TT who underwent radical nephrectomy and tumor thrombectomy from 1971 to 2012 at 22 US and European centers. Outcome measurements and statistical analysis Multivariable ordered logistic and Cox regression models were used to quantify the impact of tumor histology on CSS. Results and limitations Overall 5-yr CSS was 53.4% (confidence interval [CI], 50.5-56.2) in the entire group. TT level (according to the Mayo classification of macroscopic venous invasion in RCC) was I in 38.5% of patients, II in 30.6%, III in 17.3%, and IV in 13.5%. Histologic subtypes were clear cell renal cell carcinoma (cRCC) in 89.9% of patients, papillary renal cell carcinoma (pRCC) in 8.5%, and chromophobe RCC in 1.6%. In univariable analysis, pRCC was associated with a significantly worse CSS (p < 0.001) compared with cRCC. In multivariable analysis, the presence of pRCC was independently associated with CSS (hazard ratio: 1.62; CI, 1.01-2.61; p < 0.05). Higher TT level, positive lymph node status, distant metastasis, and fat invasion were also independently associated with CSS. Conclusions In our multi-institutional series, we found that patients with pRCC and vena cava TT who underwent radical nephrectomy and tumor thrombectomy had significantly worse cancer-specific outcomes when compared with patients with other histologic subtypes of RCC. We confirmed that higher TT level and fat invasion were independently associated with reduced CSS.
AB - Background Although different prognostic factors for patients with renal cell carcinoma (RCC) and vena cava tumor thrombus (TT) have been studied, the prognostic value of histologic subtype in these patients remains unclear. Objective We analyzed the impact of histologic subtype on cancer-specific survival (CSS). Design, settings, and participants We retrospectively analyzed the records of 1774 patients with RCC and TT who underwent radical nephrectomy and tumor thrombectomy from 1971 to 2012 at 22 US and European centers. Outcome measurements and statistical analysis Multivariable ordered logistic and Cox regression models were used to quantify the impact of tumor histology on CSS. Results and limitations Overall 5-yr CSS was 53.4% (confidence interval [CI], 50.5-56.2) in the entire group. TT level (according to the Mayo classification of macroscopic venous invasion in RCC) was I in 38.5% of patients, II in 30.6%, III in 17.3%, and IV in 13.5%. Histologic subtypes were clear cell renal cell carcinoma (cRCC) in 89.9% of patients, papillary renal cell carcinoma (pRCC) in 8.5%, and chromophobe RCC in 1.6%. In univariable analysis, pRCC was associated with a significantly worse CSS (p < 0.001) compared with cRCC. In multivariable analysis, the presence of pRCC was independently associated with CSS (hazard ratio: 1.62; CI, 1.01-2.61; p < 0.05). Higher TT level, positive lymph node status, distant metastasis, and fat invasion were also independently associated with CSS. Conclusions In our multi-institutional series, we found that patients with pRCC and vena cava TT who underwent radical nephrectomy and tumor thrombectomy had significantly worse cancer-specific outcomes when compared with patients with other histologic subtypes of RCC. We confirmed that higher TT level and fat invasion were independently associated with reduced CSS.
KW - Clear cell
KW - Histology
KW - Papillary
KW - Prognosis
KW - Renal cell carcinoma
KW - Survival
KW - Vena cava tumor thrombus
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UR - http://www.scopus.com/inward/citedby.url?scp=84905918842&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2013.06.048
DO - 10.1016/j.eururo.2013.06.048
M3 - Article
C2 - 23871402
AN - SCOPUS:84905918842
SN - 0302-2838
VL - 66
SP - 577
EP - 583
JO - European Urology
JF - European Urology
IS - 3
ER -