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09-04-2012 | Surgery | Article

Papillary RCC patients at low risk for tumor recurrence and death


Free abstract

MedWire News: Patients with papillary renal cell carcinoma (pRCC) have a low risk for tumor recurrence and cancer-related death after surgery, suggest study findings.

The findings also showed that lymph node stage, metastases, and Fuhrman nuclear grade are independent predictors for cancer-related outcomes.

"Because pRCC only affects 10-15% of kidney cancer patients, the small number of patients enrolled in individual studies makes it hard to draw meaningful conclusions about how the disease will progress," said lead study author Vincenzo Ficarra (University of Padua, Italy) in an associated press release.

"Bringing together data on 577 patients from 16 academic centers across Italy has enabled us to study this subtype in more detail than a single-center study would allow," he added.

Patients with pRCC were identified from a multicenter retrospective database between 1995 and 2007. Regression analysis was then performed to identify prognostic factors predictive of recurrence-free survival (RFS) and cancer-specific survival (CSS) after surgery.

At baseline, patients were aged on average 62.4 years and the 64% had presented with incidental symptoms. Pathologic tumor size ranged from 3 cm to 7 cm, averaging at a median size of 4.3 cm.

A pT1a and pT1b T stage was present in 43.7% and 23.0% of patients. In addition, the majority of patients (97%) had a M0 stage, and 60% presented with a pNx N stage, followed by 33% with a pN0 stage. The most common Fuhrman grade was G2 (52%), followed by G3 (25%).

The majority of patients (62%) underwent radical nephrectomy, followed by elective nephron-sparing surgery (32%).

After a median follow up of 39.2 months, 14% of patients experienced disease progression and 11% of patients had died from disease. In total, 81% of patients were alive and disease-free at a median follow up of 42 months.

The overall mean 5- and 10-year rates for RFS were 85.5% and 73.1%, with multivariate analysis identifying pathologic N stage, M stage, and Fuhrman nuclear grade as independent predictors of RFS. Conversely, pathologic T stage was not found to be a significant predictor for RFS.

Similar rates were observed for 5- and 10-year CSS, at 87.9% and 83.3%. Independent predictors for CSS identified by multivariate analysis were identical to those for RFS.

In the current study, 60% of patients were classified as N stage pNx, 97% as M stage M0, and 52% as Fuhrman grade G2 (indicating a low grade). In total, 10% of patients had tumors presenting at multiple sites.

"Our multicenter study shows that patients with pRCC face low tumor re-occurrence and cancer-related death rates," said Ficarra, adding: "It also identifies the main independent predictors of cancer-related outcomes as being pathological lymph node stage, presence of secondary cancer, and Fuhrman nuclear grade."

The findings are published in BJU International.

By Ingrid Grasmo

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