AUA 2018: Comparative Analysis of Outcomes of Papillary Type 1 and Type 2 and clear Cell Renal Cell Carcinoma: A Multi-Institutional Study

San Francisco, CA (UroToday.com) Compared to Clear Cell Renal Cell Carcinoma (ccRCC), papillary RCC (pRCC) has been thought of as lower risk pathology associated with higher cancer specific survival (CSS). The impact of histophatological subtypes of pRCC on outcomes is controversial.  In this study the authors divided the cohort into analytical subgroups based on histology (ccRCC vs. pRCC type I vs. pRCC type II). The primary end-point was overall (OS) and the secondary endpoint was Cancer specific survival (CSS). Kaplan-Meier survival (KMS) and multivariable regression model were used to estimate 5- and 10- year OS and CSS rates and the predictors associated with CSS.  



A total of 6377 patients were analyzed (pRCC type I n = 469, pRCC type II n = 473 and ccRCC n= 5435). MVA revealed that increasing tumor size (OR 1.225, p < 0.001), pRCC type I vs. ccRCC (OR 0.482, p = 0.002), higher Fuhrman grade (OR 2.409, p = 0.009), lymphovascular invasion (OR 2.735, p = 0.018) and necrosis in pathology (OR 1.976, p = 0.035) were significant risk factors for cancer specific mortality (Table). KMS showed that OS rates in patients with pRCC type I, II and ccRCC were 82, 74 and 76% at 5 years and 72.5, 48, 60.3% at 10 years, respectively (p =0.001) (Figure below). CSS rates in patients with pRCC type I, II and ccRCC were 98, 90.6 and 86.6% at 5 years and 97.5, 78.3 and 79.5% at 10 years, respectively (p < 0.001) (Figure below). 

The authors concluded that pRCC type II represents a higher risk than histopathological subtype pRCC Type I, with oncological outcomes comparable to ccRCC. More studies should be performed to address the increased risk of pRCC type 2. 

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Presented By: Ahmet Bindayi, La Jolla, CA, USA 

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre Twitter: @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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