Prognostic significance of Fuhrman grade and age for cancer-specific and overall survival in patients with papillary renal cell carcinoma: results of an international multi-institutional study on 2189 patients

Because the prognostic impact of the clinical and pathological features on cancer-specific survival (CSS) and overall survival (OS) in patients with papillary renal cell carcinoma (papRCC) is still controversial, we want to assess the impact of clinicopathological features, including Fuhrman grade and age, on survival in surgically treated papRCC patients in a large multi-institutional series.

We established a comprehensive multi-institutional database of surgically treated papRCC patients. Histopathological data collected from 2189 patients with papRCC after radical nephrectomy or nephron-sparing surgery were pooled from 18 centres in Europe and North America. OS and CSS probabilities were estimated using the Kaplan-Meier method. Multivariable competing risks analyses were used to assess the impact of Fuhrman grade (FG1-FG4) and age groups (<50 years, 50-75 years, >75 years) on cancer-specific mortality (CSM).

CSS and OS rates for patients were 89 and 81% at 3 years, 86 and 75% at 5 years and 78 and 41% at 10 years after surgery, respectively. CSM differed significantly between FG 3 (hazard ratio [HR] 4.22, 95% confidence interval [CI] 2.17-8.22; p < 0.001) and FG 4 (HR 8.93, 95% CI 4.25-18.79; p < 0.001) in comparison to FG 1. CSM was significantly worse in patients aged >75 (HR 2.85, 95% CI 2.06-3.95; p < 0.001) compared to <50 years.

FG is a strong prognostic factor for CSS in papRCC patients. In addition, patients older than 75 have worse CSM than patients younger than 50 years. These findings should be considered for clinical decision making.

World journal of urology. 2017 Aug 23 [Epub ahead of print]

H Borgmann, M Musquera, A Haferkamp, A Vilaseca, T Klatte, S F Shariat, A Scavuzzo, M A Jimenez Rios, I Wolff, U Capitanio, P Dell'Oglio, L M Krabbe, E Herrmann, T Ecke, D Vergho, N Huck, N Wagener, S Pahernik, S Zastrow, M Wirth, C Surcel, C Mirvald, K Prochazkova, G Hutterer, R Zigeuner, L Cindolo, M Hora, C G Stief, M May, S D Brookman-May

Department of Urology, University Hospital Mainz, Mainz, Germany., Hospital Clínic, University of Barcelona, Barcelona, Spain. ., Hospital Clínic, University of Barcelona, Barcelona, Spain., Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, Instituto Nacional de Cancerologia-INCan, Mexico City, Mexico., Carl-Thiem-Klinikum Cottbus, Cottbus, Germany., IRCCS San Raffaele Scientific Institute Department of Urology, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, University of Muenster Medical Center, Münster, Germany., Department of Urology, HELIOS Hospital Bad Saarow, Bad Saarow, Germany., Department of Urology and Paediatric Urology, Julius-Maximilians-University Medical Centre of Würzburg, Würzburg, Germany., Mannheim Medical Center, Department of Urology, University of Heidelberg, Heidelberg, Germany., Department of Urology, University Hospital Heidelberg, Heidelberg, Germany., Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany., Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania., Department of Urology, Faculty Hospital, Faculty of Medicine, Charles University in Pilsen, Pilsen, Czech Republic., Department of Urology, Medical University Graz, Graz, Austria., Department of Urology, ASL Abruzzo 2, Chieti, Italy., Department of Urology, Ludwig-Maximilians-University, Campus Grosshadern, Marchionistrasse 15, Munich, 81377, Germany., Department of Urology, Klinikum St. Elisabeth Straubing, Straubing, Germany., Department of Urology, Ludwig-Maximilians-University, Campus Grosshadern, Marchionistrasse 15, Munich, 81377, Germany. .

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