Comparisons of Outcome and Prognostic Features Among Histologic Subtypes of Renal Cell Carcinoma

Abstract

Our objective was to compare cancer-specific survival and to examine associations with outcome among the histologic subtypes of renal cell carcinoma (RCC). We studied 2385 patients whose first surgery between 1970 and 2000 was a radical nephrectomy for sporadic, unilateral RCC. All RCC tumors were classified following the 1997 Union Internationale Contre le Cancer and American Joint Committee on Cancer guidelines. There were 1985 (83.2%) patients with clear cell, 270 (11.3%) with papillary, 102 (4.3%) with chromophobe, 6 (0.3%) with collecting duct, 5 (0.3%) with purely sarcomatoid RCC and no underlying histologic subtype, and 17 (0.7%) with RCC, not otherwise specified. Cancer-specific survival rates at 5 years for patients with clear cell, papillary, and chromophobe RCC were 68.9%, 87.4%, and 86.7%, respectively. Patients with clear cell RCC had a poorer prognosis compared with patients with papillary and chromophobe RCC (p <0.001). This difference in outcome was observed even after stratifying by 1997 tumor stage and nuclear grade. There was no significant difference in cancer-specific survival between patients with papillary and chromophobe RCC (p = 0.918). The 1997 TNM stage, tumor size, presence of a sarcomatoid component, and nuclear grade were significantly associated with death from clear cell, papillary, and chromophobe RCC. Histologic tumor necrosis was significantly associated with death from clear cell and chromophobe RCC, but not with death from papillary RCC. Our results demonstrate that there are significant differences in outcome and associations with outcome for the different histologic subtypes of RCC, highlighting the need for accurate subtyping.

The Wilms' tumour suppressor WT1 is involved in endothelial cell proliferation and migration: expression in tumour vessels in vivo

“…In comparison, Mikami et al (2006) reported less ETS-1 expression and vascularization in papillary carcinoma compared to clear cell carcinoma. Furthermore, a better prognosis for patients with renal papillary carcinoma than for patients with renal clear cell carcinoma has been described by Cheville et al (2003). Whether a worse prognosis for patients might be due to a WT1-dependent upregulation of ETS-1 and subsequent increased vascularization cannot be answered at present, but the use of inducible WT1 conditional knockout mice in tumour models (currently under investigation) will shed light into the role of WT1 for tumour angiogenesis in vivo.…”

Identification of differentially expressed genes in clear cell renal cell carcinoma by analysis of full-length enriched cDNA library

“…One third of the RCC patients develop metastasis at presentation with a poor 5-year survival because there is no early warning sign [3]. At least five types of RCC were found, and the majority (>80%) are classified as clear cell RCC (ccRCC) [4].…”

Overexpression of the polarity protein PAR‐3 in clear cell renal cell carcinoma is associated with poor prognosis

“…1 The most common histological RCC subtype is the conventional or clear cell carcinoma (ccRCC), which accounts for 70-75% of cases. 2,3 At least 60% of ccRCCs have deletions or translocations involving the short arm of chromosome 3, which contains the von Hippel-Lindau (VHL) gene at 3p25. 4,5 The second most common cytogenetic abnormality associated with ccRCC is a gain of chromosome 5q 6 ; however, very little is known about its effects.…”