Using the National Cancer Database (NCDB), the authors identified 670 patients diagnosed with collecting duct carcinoma and 128 patients with renal medullary carcinoma from 2004 to 2014. Demographic, clinical and pathological variables were summarized with descriptive statistics. OS was estimated for the overall cohort and stratified by TNM staging using the Kaplan-Meier method. Multivariable models adjusting for confounders were used to evaluate the association between a positive surgical margin, cN+, treatment type, and OS. For patients with collecting duct carcinoma, 23.1% presented with nodal metastases, 35.2% with distant metastases and 83.4% with high grade tumor. The 3-year OS was 33.1% (median survival time, 16.8 months). cN+ vs. cN0 was associated with worse OS (HR 1.28, 95%CI 1.03-2.34, p = 0.035), and for patients with clinically localized collecting duct carcinoma (n=166), a positive surgical margin (n=10, 6.2%) was associated with worse OS (HR 1.18, 95%CI 1.37-7.17, p=.004). For metastatic patients, nephrectomy + systemic therapy was associated with improved OS compared to nephrectomy alone (HR 0.67, 95%CI 0.50-0.89, p = 0.007) but not compared to systemic therapy alone (HR 0.81, 95%CI 0.55-1.19, p = 0.298). For patients with renal medullary carcinoma, 40.9% presented with nodal metastases, 62.1% with distant metastases, and 96% with high grade tumor. The 3-year OS was 10.8% (median survival time, 9.5 months).
Nephrectomy + systemic therapy was not associated with improved OS compared to nephrectomy alone (HR 0.76, 95%CI 0.48-1.21, p = 0.248) or systemic therapy alone (HR 0.99, 95%CI 0.43-2.28, p = 0.978).
In summary, adverse pathologic features with poor survival are common for patients with collecting duct carcinoma and renal medullary carcinoma. Systemic therapy + nephrectomy was found to be associated with improved OS for patients with metastatic collecting duct carcinoma. Prospective studies are needed to identify effective treatment strategies in patients with these aggressive and lethal forms of renal cancer.
Presented by: Alp Tuna Beksac MD¹,
Co-Authors: David Paulucci MS², Harry Anastos MD², Kyle Blum MD², John Sfakianos MD² and Ketan Badani MD²
Affiliation: ¹Icahn School of Medicine at Mount Sinai, New York City, NY; ²Icahn School of Medicine at Mount Sinai, New York, NY
Written by: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC