SUO 2018: Renal Biopsy Cell Cycle Proliferation (CCP) Score Predicts Adverse Surgical Pathology in Renal Cell Carcinoma

Phoenix, Arizona ( The role of renal mass biopsy (RMB) has significantly expanded in the last decade in an attempt to improve the risk stratification of patients given the variability in malignant risk. With recent improvements in image-guided equipment and technique, RMB is safe and associated with improved diagnostic yield (∼90%), but its ability to accurately assess tumor grade and adverse pathology is still limited. Cell cycle proliferation (CCP) scores measured in nephrectomy specimens have previously been shown to be associated with renal cell carcinoma (RCC) and may be useful adjuncts to RMB. Tosoian et al aimed to determine whether the CCP score can improve risk stratification after RMB in patients with localized RCC.

A retrospective review was performed of patients with RCC who underwent RMB and subsequent partial or radical nephrectomy at the University of Michigan or Massachusetts General Hospital between 2000-2014. Using the initial RMB sample, CCP scores were generated, and analyses were performed to determine associations between CCP scores and adverse pathology at the time of surgery (defined as Fuhrman grade 3-4, ≥pT3 tumor stage, papillary II histology, and evidence of nodal or distant metastases at surgery).

After applying exclusion criteria, a total of 205 patients were included in the analysis. They found that 95 (46%) had adverse pathology at the time of surgery. Patients with adverse pathology were older (65 vs 60 years, p=0.008), more frequently male (74% vs 55%, p=0.005). Of the patients who had high grade pathology on RMB, 18/19 (95%) had adverse pathology at surgery, but, 53/113 (47%) of patients with low grade pathology on RMB also had adverse pathology at the time of surgery. On multivariable analyses, CCP score was associated with an overall 2-fold increased risk of adverse pathology (OR 1.85 95% CI 1.01-3.47, p=0.048). Interestingly, this association was even stronger when only patients with low grade (Fuhrman grade 1 or 2) tumors were evaluated (n=186).

In conclusion, CCP score was significantly associated with adverse surgical pathology independent of Fuhrman grade, suggesting that it may be a useful adjunct for risk stratification in addition to RMB. Interestingly, CCP was more strongly associated with adverse pathology in patients with low grade tumors, suggesting an even more valuable role in patients diagnosed with low grade tumors at biopsy, especially if they are considering surveillance.

Presented By: Marc A. Dall’Era, MD, University of California, Davis

Written by: Selma Masic, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA, at the 19th Annual Meeting of the Society of Urologic Oncology (SUO), November 28-30, 2018 – Phoenix, Arizona