Outcome of papillary versus clear cell renal cell carcinoma varies significantly in non-metastatic disease

Abstract

Renal cell carcinoma (RCC) comprises a heterogenous group of tumors. Traditionally, papillary RCC (pRCC) is associated with a favorable outcome compared to clear cell RCC (ccRCC), while other series report equivalent or worse prognosis. In this paper we comparatively evaluate outcome of pRCC versus ccRCC in two large multi-institutional databases (cohort study), including distribution of pRCC subtypes 1 and 2. Retrospective data of 1,943 surgically treated pRCC patients from 17 European/ North American centers between 1984-2015 were compared to 5,600 ccRCC patients from a database comprising 11 European/ North American centers . Median follow-up was 64.6 months. Differences between pRCC, subtypes, and ccRCC were compared with t-tests, Chi^2-tests, and exact Fisher tests. Cancer-specific mortality was analyzed with cumulative incidence curves and Cox cause-specific hazard models. The robustness of our results was examined with sensitivity analyses. We present that cancer-specific mortality rates and variables as stage, lymph node, and distant metastasis differ significantly between groups. Furthermore, we demonstrate that patients with non-metastatic pRCC had a significantly better cancer-specific mortality (HR 0.76, p = 0.007), when compared to ccRCC. Additionally, pRCC type 2 versus ccRCC exhibited no difference in cancer-specific mortality (HR 0.9, p = 0.722), whereas pRCC type 1 versus ccRCC displayed a risk of death reduced by 69% (p = 0.044). Taken together, outcome of pRCC versus ccRCC varies significantly in non-metastatic PLOS ONE | https://doi.org/10.1371/journal.pone

Comprehensive subgroup analyses of survival outcomes between clear cell renal cell adenocarcinoma and papillary renal cell adenocarcinoma

“…For example, some studies concluded that the prognosis of localized pRCC was more favorable than that of ccRCC, while the prognosis of advanced/metastatic pRCC was worse than that of ccRCC 6‐8 . However, conflicting results were observed in other studies, in which metastatic pRCC and metastatic ccRCC had similar prognoses 9,10 …”

Prognostic models in papillary renal cell carcinoma

“…The notion that different histologic subtypes harbor varying biologic capacities has long been appreciated and has different implications in the early-stage and advanced setting. Indeed, large cohort studies of patients with nonmetastatic papillary RCC (PRCC) demonstrate favorable outcomes compared to ccRCC patients, while PRCC patients fared worse than their ccRCC counterparts in the metastatic setting (6,7).…”