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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (4): 615-620. doi: 10.19723/j.issn.1671-167X.2022.04.006

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Clinicopathological features and prognostic analysis of papillary renal cell carcinoma

Er-shu BO1,Peng HONG1,Yu ZHANG1,Shao-hui DENG1,Li-yuan GE1,Min LU2,Nan LI3,Lu-lin MA1,Shu-dong ZHANG1,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Pathology, Peking University Third Hospital, Beijing 100191, China
    3. Research Centre of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-04-06 Online:2022-08-18 Published:2022-08-11
  • Contact: Shu-dong ZHANG E-mail:zhangshudong@bjmu.edu.cn
  • Supported by:
    the National Natural Science Foundation of China(82072828);Key Clinical Projects of Peking University Third Hospital(BYSYZD2019016);Innovative Transformation Projects of Haidian District(HDCXZHKC2021208)

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Abstract:

Objective: To investigate the clinicopathological features and prognostic characteristics of papillary renal cell carcinoma (pRCC). Methods: The clinical data of 114 patients with pRCC, including 91 males and 23 females, admitted to the Department of Urology, Peking University Third Hospital from May 2012 to May 2021 were retrospectively analyzed. All the cases were operated patients with clear pathological diagnosis and complete follow-up data. The log-rank test was used to analyze the relationship between the patients' clinicopathological characteristics and survival time, the Kaplan-Meier method to draw survival curves, and the Cox regression model for univariate and multifactorial analysis. Results: The mean age of the 114 patients was (57.3±12.6) years. The tumors were located in the left kidney in 49 cases and in the right kidney in 65 cases. In the study, 48 radical nephrectomies and 66 partial nephrectomies were performed, 42 cases were type 1 and 72 cases were type 2, and the mean maximum tumor diameter was (5.5±3.6) cm. pT1a stage 52 cases, pT1b stage 22 cases, pT2 stage 4 cases, pT3 stage 33 cases, and pT4 stage 3 cases were staged. According to the World Health Organization / International Society of Urological Pathology (WHO/ISUP), there were 13 cases of gradeⅠ, 44 cases of grade Ⅱ, 51 cases of grade Ⅲ, and 6 cases of grade Ⅳ. And 34 of the 114 patients had vascular cancer embolism, 30 cases had lymph node metastasis, and 3 cases had adrenal metastasis. The median follow-up time after surgery was 22 months, and the 3-year progression-free survival rate was 95.6%. The patients with type 1 and type 2 pRCC showed statistically significant differences in age (P=0.046), body mass index (P=0.008), surgical approach (P=0.001), maximum tumor diameter (P < 0.001), vascular cancer embolism (P < 0.001), lymph node metastasis (P < 0.001), pT stage (P < 0.001), and nuclear grade (P < 0.001). The 3-year progression-free survival rates for type 1 and type 2 pRCC were 100% and 69.4%, respectively, with type 1 having a significantly better prognosis than with type 2 (P=0.003). Univariate analysis of the patients with type 2 pRCC showed that pT stage (P < 0.001), vascular cancer embolism (P < 0.001) and lymph node metastasis (P < 0.001) were strongly associated with their prognosis. Multifactorial analysis showed that vascular cancer embolism was an independent prognostic factor for progression-free survival in type 2 pRCC (P=0.001). Univariate analysis of the pRCC patients undergoing radical nephrectomy showed that pT stage (P=0.006), vascular cancer embolism (P=0.001), and lymph node metastasis (P=0.008) were significant factors affecting their prognosis, and further multifactorial analysis showed that only vascular cancer embolism was an indepen-dent prognostic factor for their progression-free survival (P=0.006). Conclusion: Type 2 pRCC has more morbidity, more lymph node metastases, more advanced pT stage, and higher pathologic grading than type 1 pRCC. The presence of vascular cancer embolism is an independent prognostic factor in patients with type 2 pRCC and pRCC undergoing radical nephrectomy.

Key words: Papillary renal cell carcinoma, Clinical features, Clinical pathology, Prognosis

CLC Number: 

  • R737.11

Table 1

Clinicopathological features of 114 pRCC patients"

Items Value
Gender, n(%)
  Male 91 (79.8)
  Female 23 (20.2)
Age/years, $\bar x \pm s$ 57.3±12.6
BMI/(kg/m2), $\bar x \pm s$ 25.1±3.1
Tumor location, n(%)
  Left 49 (43.0)
  Right 65 (57.0)
Surgical method, n(%)
  Partial nephrectomy 66 (57.9)
  Radical nephrectomy 48 (42.1)
Maximum tumor diameter/cm, $\bar x \pm s$ 5.5±3.6
pT stages, n(%)
  T1a 52 (45.6)
  T1b 22 (19.3)
  T2 4 (3.5)
  T3 33 (28.9)
  T4 3 (2.6)
Nuclear grade, n(%)
  Ⅰ 13 (11.4)
  Ⅱ 44 (38.6)
  Ⅲ 51 (44.7)
  Ⅳ 6 (5.3)
Vascular cancer embolism, n(%)
  Yes 34 (29.8)
  No 80 (70.2)
Adrenal metastasis, n(%)
  Yes 3 (2.6)
  No 111 (97.4)
Lymph node metastasis, n(%)
  Yes 30 (26.3)
  No 84 (73.7)
Symptoms, n(%)
  Osphyalgia 17 (14.9)
  Hematuria 19 (16.7)
  Physical examination found 78 (68.4)

Table 2

Comparison of the clinicopathological features of type 1 and type 2 pRCC"

Items Type 1 Type 2 P
Gender, n 0.231
  Male 36 55
  Female 6 17
Age/years, $\bar x \pm s$ 54.1±11.5 59.0±12.9 0.046
BMI/(kg/m2), $\bar x \pm s$ 26.1±2.9 24.5±3.1 0.008
Tumor location, n 0.421
  Left 16 33
  Right 26 39
Surgical method, n 0.001
  Partial nephrectomy 33 33
  Radical nephrectomy 9 39
Maximum tumor
diameter/cm, $\bar x \pm s$		 3.55±2.30 6.63±3.69 < 0.001
Vascular cancer embolism, n < 0.001
  Yes 1 33
  No 41 39
Lymph node metastasis, n < 0.001
  Yes 0 30
  No 42 42
Adrenal metastasis, n 0.463
  Yes 0 3
  No 42 69
pT stages, n < 0.001
  T1a 28 24
  T1b 10 12
  T2 2 2
  T3 1 32
  T4 1 2
Nuclear grade, n < 0.001
  Ⅰ 13 0
  Ⅱ 24 20
  Ⅲ 5 46
  Ⅳ 0 6
Symptoms, n 0.002
  Osphyalgia 3 14
  Hematuria 2 17
  Physical examination found 37 41

Figure 1

Progression-free survival curves in patients with type 1 and type 2 pRCC after surgery"

Table 3

Univariate and multifactorial analysis of the prognosis associated with type 2 pRCC patients"

Items Univariate analysis Multifactorial analysis
(P)
HR 95%CI P
Gender (Male/Female) 0.296 0.038-2.295 0.215
BMI (>24.9 kg/m2/≤24.9 kg/m2) 0.913 0.290-2.871 0.876
Tumor location (Left/Right) 0.799 0.256-2.498 0.700
Surgical method (Radical/Partial) 3.316 0.886-12.417 0.055 0.100
pT stages (T3-4/ T1-2) 12.495 2.605-59.929 < 0.001 0.584
Nuclear grade (Ⅲ-Ⅳ / Ⅰ-Ⅱ) 1.333 0.391-4.541 0.641
Vascular cancer embolism (Yes/No) 34.301 3.983-295.376 < 0.001 0.001
Lymph node metastasis (Yes/No) 15.257 2.767-84.121 < 0.001 0.558
Adrenal metastasis (Yes/No) 4.009 0.488-32.905 0.274

Figure 2

Progression-free survival curves in patients with type 2 pRCC with and without vascular cancer embolism"

Figure 3

Progression-free survival curves in pRCC patients undergoing partial nephrectomy and radical nephrectomy"

Table 4

Univariate and multifactorial analysis of the prognosis of patients with pRCC after radical nephrectomy"

Items Univariate analysis Multifactorial analysis
(P)
HR 95%CI P
BMI (>24.9/≤24.9 kg/m2) 0.655 0.173-2.477 0.537
Tumor location (Left/Right) 0.984 0.258-3.759 0.982
Nuclear grade (Ⅲ-Ⅳ / Ⅰ-Ⅱ) 2.300 0.494-10.722 0.275
pT stages (T3-4/ T1-2) 7.412 1.503-36.540 0.006 0.452
Vascular cancer embolism (Yes/No) 21.445 2.455-187.305 0.001 0.006
Lymph node metastasis (Yes/No) 10.386 1.241-86.938 0.008 0.499
Adrenal metastasis (Yes/No) 3.380 0.392-29.172 0.334
pRCC (Type 1 / Type 2) 0.863 0.331-2.674 0.132 0.493

Table 5

Univariate analysis of prognosis in pRCC patients with high pT stage"

Items HR 95%CI P
Gender (male/female) 0.281 0.035-2.270 0.163
BMI (>24.9 / ≤24.9 kg/m2) 1.379 0.385-4.944 0.626
Tumor location (Left/Right) 1.359 0.361-5.113 0.649
Surgical method (Radical/Partial) 1.815 0.465-7.079 0.375
Nuclear grade (Ⅲ-Ⅳ / Ⅰ-Ⅱ) 1.009 0.242-4.205 0.990
Vascular cancer embolism (Yes/No) 35.011 0.015-82 945.630 0.058
Lymph node metastasis (Yes/No) 1.994 0.395-10.068 0.376
Adrenal metastasis (Yes/No) 1.931 0.230-16.217 0.575
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