Clinically localized type 1 and 2 papillary renal cell carcinomas have similar survival outcomes following surgery

Ledezma, Rodrigo; Negron, Edris; Paner, Gladell P.; Rjepaj, Chris; Lascano, Danny; Haseebuddin, Mohammed; Dangle, Pankaj P.; Shalhav, Arieh L.; Crist, Henry; Raman, Jay D.; DeCastro, G. Joel; Harik, Lara; Paroder, Monika; Uzzo, Robert G.; Kutikov, Alexander; Eggener, Scott E.

doi:10.1007/s00345-015-1692-3

Cited by 28 publications

(25 citation statements)

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“…Papillary RCC (PRCC) is the second most common subtype and accounts for 15% of all cases [2]. PRCC is often subdivided into type 1 and 2, but studies did not confirm the independent prognostic value of PRCC type in localised disease [3, 4]. Compared with conventional clear cell RCC, PRCC is thought to have a more favourable prognosis in the non-metastatic stage [5], while patients with metastatic disease have worse outcomes than their counterparts [6].…”

Section: Introductionmentioning

confidence: 99%

The VENUSS prognostic model to predict disease recurrence following surgery for non-metastatic papillary renal cell carcinoma: development and evaluation using the ASSURE prospective clinical trial cohort

Klatte

Afferi

Volpe

et al. 2019

BMC Med

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Background The current World Health Organization classification recognises 12 major subtypes of renal cell carcinoma (RCC). Although these subtypes differ on molecular and clinical levels, they are generally managed as the same disease, simply because they occur in the same organ. Specifically, there is a paucity of tools to risk-stratify patients with papillary RCC (PRCC). The purpose of this study was to develop and evaluate a tool to risk-stratify patients with clinically non-metastatic PRCC following curative surgery. Methods We studied clinicopathological variables and outcomes of 556 patients, who underwent full resection of sporadic, unilateral, non-metastatic (T1–4, N0–1, M0) PRCC at five institutions. Based on multivariable Fine-Gray competing risks regression models, we developed a prognostic scoring system to predict disease recurrence. This was further evaluated in the 150 PRCC patients recruited to the ASSURE trial. We compared the discrimination, calibration and decision-curve clinical net benefit against the Tumour, Node, Metastasis (TNM) stage group, University of California Integrated Staging System (UISS) and the 2018 Leibovich prognostic groups. Results We developed the VENUSS score from significant variables on multivariable analysis, which were the presence of VEnous tumour thrombus, NUclear grade, Size, T and N Stage. We created three risk groups based on the VENUSS score, with a 5-year cumulative incidence of recurrence equalling 2.9% in low-risk, 15.4% in intermediate-risk and 54.5% in high-risk patients. 91.7% of low-risk patients had oligometastatic recurrent disease, compared to 16.7% of intermediate-risk and 40.0% of high-risk patients. Discrimination, calibration and clinical net benefit from VENUSS appeared to be superior to UISS, TNM and Leibovich prognostic groups. Conclusions We developed and tested a prognostic model for patients with clinically non-metastatic PRCC, which is based on routine pathological variables. This model may be superior to standard models and could be used for tailoring postoperative surveillance and defining inclusion for prospective adjuvant clinical trials.

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Section: Introductionmentioning

confidence: 99%

The VENUSS prognostic model to predict disease recurrence following surgery for non-metastatic papillary renal cell carcinoma: development and evaluation using the ASSURE prospective clinical trial cohort

Klatte

Afferi

Volpe

et al. 2019

BMC Med

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“…Ledezma et al studied 627 patients with PRCC undergoing surgery and observed that 48 (8%) experienced relapse of which 10 out of 27 patients with papillary type 2 RCC exhibited metastatic disease in the lymph nodes, whereas most patients with type 1 PRCC (11/21) metastasized to the lungs [13].…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted Retroperitoneal Lymphadenectomy In A Patient With Type I Papillary Renal Cancer Recurrence After Five Years Of Follow-Up: A Case Report.

Salhi

Fuschi

Velotti

et al. 2020

Preprint

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INTRODUCTION: Papillary renal cell carcinoma is a rare cancer and is the second most frequent histologic type among all renal cell carcinoma, accounting for up to 15%. Patients with type 1 PRCC are diagnosed at a lower stage and present a lower nuclear grade compared to type 2.CASE PRESENTATION: A 72-year-old man underwent a right radical nephrectomy 7 years ago for a 10 cm mesorenal mass with a final histopathological diagnosis of a papillary renal cell carcinoma type 1 pT2a with negative surgical margins.Five years after the surgery, computed tomography (CT) scan imaging showed the presence of multiple masses suspicious for node recurrences disease localized in the renal lodge, in the inter-aorto-caval space, at the iliac vessel bifurcation and right common iliac vessels. Patient underwent a robotic retroperitoneal lymphadenectomy. The operative time was 114 min, estimated blood loss 200 ml; length of hospital stay 4 days. The abdominal drainage was removed at first post-operative day. No perioperative complications. The removed lesions confirmed on histopathological examination the recurrence of type I papillary renal cancer at: renal lodge, inter-aorto-caval space, iliac bifurcation, common iliac lymph nodes. No further recurrences on surveillance imaging 24 months after his procedure.DISCUSSION AND CONCLUSION: We present the first description of minimally invasive surgical excision for a papillary type I renal cancer nodal recurrence and renal fossa recurrence.Our present study shows that patients treated with surgical excision for isolated RPLN recurrences may afford select patient durable cancer control.The robotic approach can be offered as an effective modality of treatment in this rare case of type I papillary renal cancer metastases.The extent of resection, as well as the optimal integration of surgery and systemic therapy, remain to be determined in this setting.

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“…Ledezma et al . [ 10 ] investigated 627 PRCC patients undergoing surgery and reported that 48 subjects experienced relapse. Ten out of 27 patients with type 2 PRCC exhibited metastatic lymph nodes, whereas most type 1 PRCC patients (11 of 21) reported pulmonary metastases.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted retroperitoneal lymphadenectomy in patient with type I papillary renal cancer recurrence after 5 years of follow-up

Salhi

Fuschi

Velotti

et al. 2020

Journal of Surgical Case Reports

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Papillary renal cell carcinoma (PRCC) is a rare cancer and is the second most frequent histologic type among all renal cell carcinoma, accounting for up to 15%. A 72-year-old man underwent a right radical nephrectomy 7 years ago with final histopathology diagnosis of type 1 PRCC with negative surgical margins. Five years after surgery, computed tomography scan imaging showed the presence of multiple masses suspicious for node recurrences disease localized in the renal lodge, in the inter-aorto-caval space, at the iliac vessels bifurcation and right common iliac vessels. Patient underwent a robotic retroperitoneal lymphadenectomy. The histopathological examination confirmed the recurrence of type I papillary renal cancer in all the specimens. No further recurrences have been observed at 24-month follow-up after surgery. This report is the first describing a robot-assisted minimally invasive surgical excision for type I papillary renal cancer nodal and renal fossa recurrences.

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Clinically localized type 1 and 2 papillary renal cell carcinomas have similar survival outcomes following surgery

Abstract: While patients with type 2 PRCC appear to present with more advanced disease than patients with type 1, PRCC subtype does not appear to be an independent predictor of CSS, RFS or OS for treated localized disease.

Cited by 28 publications

References 28 publications

The VENUSS prognostic model to predict disease recurrence following surgery for non-metastatic papillary renal cell carcinoma: development and evaluation using the ASSURE prospective clinical trial cohort

The VENUSS prognostic model to predict disease recurrence following surgery for non-metastatic papillary renal cell carcinoma: development and evaluation using the ASSURE prospective clinical trial cohort

Robot-Assisted Retroperitoneal Lymphadenectomy In A Patient With Type I Papillary Renal Cancer Recurrence After Five Years Of Follow-Up: A Case Report.

Robot-assisted retroperitoneal lymphadenectomy in patient with type I papillary renal cancer recurrence after 5 years of follow-up

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