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Title: Clinicopathologic features associated with survival after cytoreductive nephrectomy for nonclear cell renal cell carcinoma.
Austin Authors: Silagy, Andrew W;Flynn, Jessica;Mano, Roy;Blum, Kyle A;Marcon, Julian;DiNatale, Renzo G;Sanchez, Alejandro;Carlo, Maria I;Motzer, Robert J;Coleman, Jonathan A;Russo, Paul;Ostrovnaya, Irina;Chen, Yingbei B;Ari Hakimi, A
Affiliation: Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
Department of Urology, University Hospital of Munich, Munich, Germany
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
Issue Date: Nov-2019 2019-09-12
Publication information: Urologic Oncology 2019; 37(11): 811.e9-811.e16
Abstract: To report the overall survival (OS) outcomes of patients with nonclear cell renal cell carcinoma (nccRCC) treated at our institution with a cytoreductive nephrectomy (CN) and better understand the clinical and pathological characteristics of the patients that respond best. We queried our prospectively maintained database for patients who underwent CN for nccRCC between 1989 and 2018. Histology was reviewed by an expert genitourinary pathologist, and nccRCC tumors were subdivided into papillary, unclassified, chromophobe, and other histology. Baseline clinicopathology, treatments, and survival outcomes were recorded. Preoperative hematological parameters including the neutrophil-to-lymphocyte ratio (NLR) were analyzed. Significant univariate predictors of OS were tested in a multivariate model. There were 100 nccRCC patients treated with CN. Median age was 61 years (IQR: 48-69) and 65% were male. There were 79 patient deaths with a median OS of 13.7 months (10.8-27.2). Estimated 2- and 5-year survival was 40.1% and 12.2%, respectively. Median follow-up of survivors was 13 months (IQR: 3-30). On multivariate analysis, increasing NLR (hazard ratio [HR] 1.27; 95% confidence interval [CI] 1.14-1.40, P < 0.001) and sarcomatoid features (HR 2.18; 95% CI 1.19-3.97, P = 0.014) conferred worse OS and the presence of papillary features were a favorable prognostic feature (HR 0.37; 95% CI 0.21-0.65, P < 0.001). OS outcomes in patients with nccRCC who underwent a CN are consistently modest throughout the study period. Patients with papillary features and a lower preoperative NLR may be better candidates for a CN.
DOI: 10.1016/j.urolonc.2019.07.011
PubMed URL: 31521530
Type: Journal Article
Subjects: Cytoreductive nephrectomy
Nonclear cell histology
Renal cell carcinoma
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