AUA 2018: Clinicopathological and Survival Analysis of Stage III/IV Papillary and Chromophobe Renal Cell Carcinoma: Implications for Future Clinical Trials

San Francisco, CA (UroToday.com) While clear cell histology remains the predominant histologic subtype of renal cell carcinoma, there remains a clinically significant proportion of patients who have papillary (type 1 and 2) and chromophobe histology. These histologic subtypes can have drastically different local and distance oncologic outcomes and, unfortunately, are rarely considered in clinical trials. Management is often inferred from trials treating clear cell histology predominantly. 

As has been common in recent abstracts, the authors used the National Cancer Database to evaluate the prevalence and survival of patients with advanced chromophone and papillary RCC. The NCDB is a cancer database that provides information regarding overall survival (OS), but not cancer-specific survival (CSS)! This remains a major limitation of its use.

They identified 28,344 papillary RCC (pRCC) patients and 11,942 chromophobe RCC (chRCC) patients, which comprised 25.9% of NCDB RCC cases (the majority of the remaining cases were clear cell RCC). Unfortunately, they could not further stratify pRCC into subtypes. Focusing specifically on advanced RCC (stage III and IV), they assessed OS in ccRCC, pRCC, and chRCC.

For pRCC, 14.1% of patients had stage III-IV disease with 5.4% and 4.3% of patients having nodal or distant metastases, respectively. For chRCC, 14.8% had stage III-IV disease with 2.1% and 1.8% of patients having nodal or distant metastases, respectively. 

The 5-year OS for stage III ccRCC, pRCC and chRCC was 66.9%, 63.6% and 80.5%. The 5-year OS for stage IV ccRCC, pRCC and chRCC was 19.7%, 13.3% and 22.0%. The hazard of death was significantly higher for stage IV pRCC vs. ccRCC (HR=1.29; 95% CI=1.19, 1.39; p<.001) and similar for stage IV chRCC vs. ccRCC (HR=1.01; 95% CI=0.85, 1.21; p=.885).

Ultimately, they conclude that, despite being rare, advanced stage pRCC and chRCC have similarly poor oncologic outcomes as advanced stage ccRCC. As advanced pRCC and chRCC have different histology, they likely have different mutational drivers that warrant further research – and hopefully novel therapies that can help better treat these patients!


Presented by:  Alain Kaldany, Mount Sinai Hospital, New York City
Co-Authors: David Paulucci, Harry Anastos, Alp Tuna Beksac, John Sfakianos, Ketan Badani

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, @tchandra_uromd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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