Journal of Peking University(Health Sciences) >
Clinicopathological features and prognostic analysis of papillary renal cell carcinoma
Received date: 2022-04-06
Online published: 2022-08-11
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)
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.
Er-shu BO , Peng HONG , Yu ZHANG , Shao-hui DENG , Li-yuan GE , Min LU , Nan LI , Lu-lin MA , Shu-dong ZHANG . Clinicopathological features and prognostic analysis of papillary renal cell carcinoma[J]. Journal of Peking University(Health Sciences), 2022 , 54(4) : 615 -620 . DOI: 10.19723/j.issn.1671-167X.2022.04.006
| 1 | Siegel RL , Miller KD , Jemal A . Cancer statistics, 2019[J]. CA Cancer J Clin, 2019, 69 (1): 7- 34. |
| 2 | Qu Y , Chen H , Gu W , et al. Age-dependent association between sex and renal cell carcinoma mortality: A population-based analysis[J]. Sci Rep, 2015, 5 (1): 9160. |
| 3 | Znaor A , Lortet-Tieulent J , Laversanne M , et al. International variations and trends in renal cell carcinoma incidence and mortality[J]. Eur Urol, 2015, 67 (3): 519- 530. |
| 4 | Akhtar M , Al-Bozom IA , Al Hussain T . Papillary renal cell carcinoma (PRCC): An update[J]. Adv Anat Pathol, 2019, 26 (2): 124- 132. |
| 5 | Mir MC , Derweesh I , Porpiglia F , et al. Partial nephrectomy versus radical nephrectomy for clinical T1b and T2 renal tumors: A systematic review and meta-analysis of comparative studies[J]. Eur Urol, 2017, 71 (4): 606- 617. |
| 6 | Mancilla-Jimenez R , Stanley RJ , Blath RA , et al. Papillary renal cell carcinoma a clinical, radiologic, and pathologic study of 34 cases[J]. Cancer, 1976, 38 (6): 2469- 2480. |
| 7 | Thoenes W , St?rkel S , Rumpelt HJ . Histopathology and classification of renal cell tumors (adenomas, oncocytomas and carcinomas): The basic cytological and histopathological elements and their use for diagnostics[J]. Pathol Res Pract, 1986, 181 (2): 125- 143. |
| 8 | Delahunt B , Eble JN . Papillary renal cell carcinoma: A clinicopathologic and immunohistochemical study of 105 tumors[J]. Mod Pathol, 1997, 10 (6): 537- 544. |
| 9 | Aron M , Nguyen MM , Stein RJ , et al. Impact of gender in renal cell carcinoma: An analysis of the SEER database[J]. Eur Urol, 2008, 54 (1): 133- 140. |
| 10 | Hong B , Hou H , Chen L , et al. The clinicopathological features and prognosis in patients with papillary renal cell carcinoma: A multicenter retrospective study in Chinese population[J]. Front Oncol, 2021, 11, 753690. |
| 11 | Bigot P , Bernhard JC , Gill IS , et al. The subclassification of papillary renal cell carcinoma does not affect oncological outcomes after nephron sparing surgery[J]. World J Urol, 2016, 34 (3): 347- 352. |
| 12 | 洪保安, 侯惠民, 陈凌霄, 等. 乳头状肾细胞癌的临床病理特征及预后分析[J]. 中华泌尿外科杂志, 2020, 41 (12): 896- 900. |
| 13 | 董樑, 黄吉炜, 奚倩雯, 等. 乳头状肾细胞癌的临床病理特征和预后分析[J]. 中华泌尿外科杂志, 2015, 36 (3): 183- 187. |
| 14 | Ha YS , Chung JW , Choi SH , et al. Clinical significance of subclassification of papillary renal cell carcinoma: Comparison of cli-nicopathologic parameters and oncologic outcomes between papillary histologic subtypes 1 and 2 using the Korean renal cell carcinoma database[J]. Clin Genitourin Cancer, 2017, 15 (2): e181- e186. |
| 15 | Pan H , Ye L , Zhu Q , et al. The effect of the papillary renal cell carcinoma subtype on oncological outcomes[J]. Sci Rep, 2020, 10 (1): 21073. |
| 16 | Sukov WR , Lohse CM , Leibovich BC , et al. Clinical and pathological features associated with prognosis in patients with papillary renal cell carcinoma[J]. J Urol, 2012, 187 (1): 54- 59. |
| 17 | Ku JH , Moon KC , Kwak C , et al. Is there a role of the histologic subtypes of papillary renal cell carcinoma as a prognostic factor?[J]. Jpn J Clin Oncol, 2009, 39 (10): 664- 670. |
| 18 | 黄健. 中国泌尿外科和男科疾病诊断治疗指南(2019版)[M]. 北京: 科学出版社, 2020: 6- 8. |
| 19 | Fernandes DS , Lopes JM . Pathology, therapy and prognosis of papillary renal carcinoma[J]. Future Oncol, 2015, 11 (1): 121- 132. |
| 20 | Begg CB , Cramer LD , Hoskins WJ . Impact of hospital volume on operative mortality for major cancer surgery[J]. JAMA, 1998, 280 (20): 1747- 1751. |
/
| 〈 |
|
〉 |