Renal Cell Carcinoma: Comparison between Variant Histology and Clear Cell Carcinoma across All Stages and Treatment Modalities

No AccessJournal of UrologyAdult Urology1 Oct 2020Renal Cell Carcinoma: Comparison between Variant Histology and Clear Cell Carcinoma across All Stages and Treatment ModalitiesThis article is commented on by the following:Editorial CommentEditorial Comment Marina Deuker, Franziska Stolzenbach, Giuseppe Rosiello, Carlotta Palumbo, Thomas Martin, Zhe Tian, Felix K.-H. Chun, Fred Saad, Shahrokh F. Shariat, Anil Kapoor, and Pierre I. Karakiewicz Marina DeukerMarina Deuker *Correspondence: Department of Urology, University Hospital Frankfurt, Theodor- Stern Kai 7, 60590Frankfurt, Germany telephone: +49 (0)69 6301-80076; E-mail Address: [email protected] Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada , Franziska StolzenbachFranziska Stolzenbach Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany , Giuseppe RosielloGiuseppe Rosiello Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy , Carlotta PalumboCarlotta Palumbo Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy , Thomas MartinThomas Martin Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada , Zhe TianZhe Tian Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada , Felix K.-H. ChunFelix K.-H. Chun Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany , Fred SaadFred Saad Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada , Shahrokh F. ShariatShahrokh F. Shariat Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia Department of Urology, University of Jordan, Amman, Jordan , Anil KapoorAnil Kapoor Division of Urology, Department of Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada , and Pierre I. KarakiewiczPierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada View All Author Informationhttps://doi.org/10.1097/JU.0000000000001063AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated stage at presentation and cancer specific mortality according to variant histology relative to clear cell renal cell carcinoma. Materials and Methods: Within the Surveillance, Epidemiology, and End Results registry (2001–2016) we identified variant histology and clear cell renal cell carcinoma cases. Cumulative incidence plots, multivariate Cox regression models matched for stage, grade and other patient characteristics addressed cancer specific mortality. Subgroup analyses relied on inverse probability treatment weighting according to nephrectomy type. Results: Of all 69,785 patients with renal cell carcinoma 2,495 harbored variant histology (3.6%). Of patients with variant histology 70.1% (1,748) harbored sarcomatoid vs 11.2% (280) collecting duct vs 7.6% (190) mesenchymal vs 3.8% (94) neuroendocrine vs 2.9% (72) renal medullary vs 2.5% (62) mucinous tubular and spindle cell, and 2.0% (49) rhabdoid tumors. All patients with variant histology exhibited more advanced TNM stage at diagnosis than clear cell renal cell carcinoma, except for mucinous tubular and spindle cell. After matching with G4 clear cell renal cell carcinoma, collecting duct (multivariate HR 1.6, p <0.01), sarcomatoid (HR 1.8, p <0.01), renal medullary (HR 1.7, p=0.1) and rhabdoid variant histology (HR 1.5, p=0.1) showed higher cancer specific mortality than clear cell renal cell carcinoma. No cancer specific mortality differences were recorded for mesenchymal, neuroendocrine and mucinous tubular and spindle cell variant histology. In nephrectomy subgroup higher cancer specific mortality was recorded after partial nephrectomy than radical nephrectomy in sarcomatoid variant histology after inverse probability treatment weighting and multivariate adjustment (HR 1.2, p=0.02). Conclusions: TNM stage at diagnosis is universally more advanced in patients with variant histology, except for mucinous tubular and spindle cell. Cancer specific mortality is higher in collecting duct, sarcomatoid, rhabdoid and renal medullary variant histology, but not in other variant histology. Partial nephrectomy is associated with worse survival in sarcomatoid variant histology but could not be assessed in other variant histology due to small sample size. References 1. : The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: renal, penile, and testicular tumours. Eur Urol 2016; 70: 93. Google Scholar 2. : 2004 WHO classification of the renal tumors of the adults. Eur Urol 2006; 49: 798. Google Scholar 3. : SEER Cancer Statistics Review, 1975-2016. Bethesda, Maryland: National Cancer Institute 2018. Google Scholar 4. NIH National Cancer Institute: 2000 U.S. Standard Population vs. Standard Million 2019. Available at https://seer.cancer.gov/stdpopulations/single_age.html. Accessed November 26, 2019. Google Scholar 5. : Grading of renal cell carcinoma. Histopathology 2019; 74: 4. Google Scholar 6. : Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney: a detailed study of radiological, pathological and clinical outcomes. BJU Int 2015; 116: 85. Google Scholar 7. : Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 2015; 34: 3661. Google Scholar 8. : Collecting duct (Bellini duct) renal cell carcinoma: a nationwide survey in Japan. J Urol 2006; 176: 40. Link, Google Scholar 9. : Comparison of oncologic outcomes between sarcomatoid and clear cell renal cell carcinoma. World J Urol 2016; 34: 1429. Google Scholar 10. : Management and outcomes of patients with renal medullary carcinoma: a multicentre collaborative study. BJU Int 2017; 120: 782. Google Scholar 11. : Collecting duct renal cell carcinoma: a matched analysis of 41 cases. Eur Urol 2007; 52: 1140. Google Scholar 12. : Malignant solitary fibrous tumour of the kidney with an extensive thrombus: a case report and review of the literature. Urol Case Rep 2019; 26: 100974. Google Scholar 13. : Renal cell carcinoma with rhabdoid features: an aggressive neoplasm. Histopathology 2002; 41: 538. Google Scholar 14. : Renal neuroendocrine tumors. Indian J Urol 2009; 25: 155. Google Scholar 15. : Collecting duct carcinoma of the kidney. A contribution of 4 new cases. Arch Esp Urol 2014; 67: 714. Google Scholar 16. : Neuroendocrine tumors of the kidney: a single institution experience. Clin Genitourin Cancer 2014; 12: 422. Google Scholar 17. : Malignant solitary fibrous tumor of the kidney with liver metastasis: a case report and literature review. J Cancer Res Ther 2018; 14: S1217. Google Scholar 18. : Active targeted therapy for metastatic collecting duct carcinoma of the kidney: a case report and review of the literature. Int Urol Nephrol 2013; 45: 1017. Google Scholar 19. : Collecting duct carcinoma of the native kidney in a renal transplant recipient. Case Rep Transpl 2017; 2017: 4527104. Google Scholar 20. : Outcomes of patients with sarcomatoid renal cell carcinoma: the Mayo Clinic experience. J Clin Oncol 2013; 31: 359. Google Scholar 21. : Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome. Am J Surg Pathol 2004; 28: 435. Google Scholar 22. : Survival outcomes in sarcomatoid renal cell carcinoma. J Clin Oncol 2018; 36: e16559. Google Scholar 23. : Sarcomatoid renal cell carcinoma: population-based study of 879 patients. Clin Genitourin Cancer 2019; 17: e447. Google Scholar 24. : Renal cell carcinoma with rhabdoid features. Am J Surg Pathol 2000; 24: 1329. Google Scholar 25. : Renal cell carcinoma with rhabdoid features: an aggressive neoplasm with overexpression of p53. Arch Pathol Lab Med 2007; 131: 102. Google Scholar 26. : Impact of rhabdoid differentiation on postoperative outcome for patients with N0M0 renal cell carcinoma. Urol Oncol 2019; 37: 711. Google Scholar 27. : Renal medullary carcinoma: a report of the current literature. Curr Urol Rep 2019; 20: 4. Google Scholar 28. : Sarcomatoid renal cell carcinoma: a comprehensive review of the biology and current treatment strategies. Oncologist 2012; 17: 46. Google Scholar 29. : Pathologic validation of renal cell carcinoma histology in the Surveillance, Epidemiology, and End Results program. Urol Oncol 2014; 32: 23.e9. Google Scholar 30. : Clinically nonmetastatic renal cell carcinoma with sarcomatoid dedifferentiation: natural history and outcomes after surgical resection with curative intent. Urol Oncol 2015; 33: 166.e21. Google Scholar No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byGuo B and Liu M (2021) Renal Cell Carcinoma: Comparison between Variant Histology and Clear Cell Carcinoma across All Stages and Treatment Modalities. Letter.Journal of Urology, VOL. 205, NO. 5, (1525-1525), Online publication date: 1-May-2021.Smith J (2020) This Month in Adult UrologyJournal of Urology, VOL. 204, NO. 4, (635-636), Online publication date: 1-Oct-2020.Related articlesJournal of Urology27 Jul 2020Editorial CommentJournal of Urology27 Jul 2020Editorial Comment Volume 204Issue 4October 2020Page: 671-676Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordskidney neoplasmsrenal cellcarcinomanephrectomyhistologyrhabdoid tumorMetricsAuthor Information Marina Deuker Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada *Correspondence: Department of Urology, University Hospital Frankfurt, Theodor- Stern Kai 7, 60590Frankfurt, Germany telephone: +49 (0)69 6301-80076; E-mail Address: [email protected] More articles by this author Franziska Stolzenbach Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author Giuseppe Rosiello Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy More articles by this author Carlotta Palumbo Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy More articles by this author Thomas Martin Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada More articles by this author Zhe Tian Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada More articles by this author Felix K.-H. Chun Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany More articles by this author Fred Saad Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada More articles by this author Shahrokh F. Shariat Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia Department of Urology, University of Jordan, Amman, Jordan More articles by this author Anil Kapoor Division of Urology, Department of Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada More articles by this author Pierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF downloadLoading ...