AUA 2018: Oncologic Outcomes of Simple Enucleation Partial Nephrectomy in Sporadic Type 2 Papillary Renal Cell Carcinoma

San Francisco, CA ( Papillary type 2 renal cell carcinoma (RCC) has been associated with poor prognosis and increased risk of local recurrence according to studies in patients with Hereditary Leiomyomatosis and RCC. The current recommendation for patients found to have papillary type 2 features on biopsy is for radical nephrectomy or partial nephrectomy with a wide margin. The authors aimed to assess the margin rate along with fossa recurrence rate of patients with sporadic type 2 papillary RCC who underwent simple enucleation partial nephrectomy as compared to those with clear cell RCC. 

This was a retrospective chart review of all patients with a small renal mass (4cm or less) who underwent simple enucleation partial nephrectomy and were found to have papillary type 2 RCC or clear cell RCC over a 10-year period (2006-2016). Information regarding patient demographics, surgical technique, histological subtype, grade, margin status, recurrence rate, and development of metastatic disease was collected from the medical record. All patients with known histology prior to partial nephrectomy were excluded from the study, as were patients with mixed histology or patients who underwent laparoscopic/robotic procedures. 

UroToday AUA2018 Demo Patho Characteristics

A total of 113 patients met the study criteria. Overall 24.0% of patients were found to have papillary type 2 RCC. There were more males with papillary type 2 RCC (85.2%) than clear cell (60.5%, p = 0.008) as shown in the figure. The margin rate for both groups was comparable with 11% of patients having a positive margin in the papillary type 2 group compared to 9.3% in the clear cell RCC group (p=0.78). Local recurrence was comparable with only 2 (7.4%) patients developing a fossa recurrence in the papillary type 2 group compared to 5 (5.8%) in the clear cell RCC group (p=0.76). Papillary type 2 compared to clear cell was associated with higher grade (100% vs. 22%, respectively, p < 0.001) and metastatic disease (14.8% vs. 2.3%, respectively, p=0.012) at a median 2-year follow-up. 

Therefore, the authors conclude that the margin and fossa recurrence rate seen following simple enucleation partial nephrectomy was comparable between sporadic papillary type 2 and clear cell histology. As a result, simple enucleation can be performed with acceptable surgical outcomes in sporadic papillary type 2 RCC.

Presented by: Avinash Maganty, MD, Pittsburgh, PA, USA
Co-Authors: Andres Correa, philadelphia, PA, Jathin Bandari, Ronald Hrebinko, Benjamin Davies, Jodi Maranchie, Stephen Jackman, Pittsburgh, PA

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