The Impact of Metastasis Histopathology on Oncologic Outcomes for Patients With Surgically Resected Metastatic Renal Cell Carcinoma

No AccessJournal of UrologyAdult Urology20 Jun 2023The Impact of Metastasis Histopathology on Oncologic Outcomes for Patients With Surgically Resected Metastatic Renal Cell CarcinomaThis article is commented on by the following:Editorial Comment Rodrigo Rodrigues Pessoa, Reza Nabavizadeh, Fernando Quevedo, Daniel D. Joyce, Christine M. Lohse, Vidit Sharma, Brian A. Costello, Stephen A. Boorjian, R. Houston Thompson, Bradley C. Leibovich, and John C. Cheville Rodrigo Rodrigues PessoaRodrigo Rodrigues Pessoa Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Reza NabavizadehReza Nabavizadeh Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Fernando QuevedoFernando Quevedo Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota More articles by this author , Daniel D. JoyceDaniel D. Joyce Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Christine M. LohseChristine M. Lohse Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota More articles by this author , Vidit SharmaVidit Sharma Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Brian A. CostelloBrian A. Costello Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota More articles by this author , Stephen A. BoorjianStephen A. Boorjian Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , R. Houston ThompsonR. Houston Thompson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , Bradley C. LeibovichBradley C. Leibovich Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author , and John C. ChevilleJohn C. Cheville *Correspondence: Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 telephone: 507-266-0686; E-mail Address: [email protected] Department of Laboratory Medicine and Pathology, Mayo Clinic,Rochester, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003601AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: Multiple prognostic models exist to assess survival among patients with metastatic clear cell renal cell carcinoma. However, the relative contribution of histopathological features of the metastasis has not been extensively studied. Herein, we compared models using clinical, primary tumor, and metastatic features to predict cancer-specific survival for patients with surgically resected metastatic clear cell renal cell carcinoma. Materials and Methods: We studied 266 patients who had undergone nephrectomy between 1970 and 2019, and who had a single site of metastasis completely resected. Two versions of the metastatic clear cell renal cell carcinoma score published by Leibovich et al were calculated, using grade and necrosis from the primary tumor and using grade and necrosis from the metastasis. Predictive abilities of these 2 versions and a third model that included metastatic features only were compared using c-indexes from Cox proportional hazards models. Results: A total of 197 patients died from renal cell carcinoma at a median of 2.3 years (IQR 1.1-4.5); median follow-up among survivors was 13.2 years (IQR 10.0-14.5). The Leibovich score using grade and necrosis from the metastasis (c=0.679) had similar predictive ability compared to the original Leibovich score using grade and necrosis from the primary tumor (c=0.675). A third model (c=0.707) demonstrated that metastasectomy within 2 years after nephrectomy, presence of bone metastasis, high grade, and sarcomatoid differentiation in the metastasis were significantly associated with cancer-specific survival. Conclusions: Scoring algorithms calculated using histopathological features of the metastasis can be used to predict cancer-specific survival for patients with surgically resected metastatic clear cell renal cell carcinoma. These findings are of particular importance for instances when primary tumor histopathology is not readily available. REFERENCES 1. The Cancer Genome Atlas Research Network. Comprehensive molecular characterization of clear cell renal cell carcinoma. Nature.2013; 499(7456):43-49. Crossref, Medline, Google Scholar 2. . Intratumor heterogeneity and branched evolution revealed by multiregion sequencing. N Engl J Med.2012; 366(10):883-892. Crossref, Medline, Google Scholar 3. . 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Tumor-infiltrating and peripheral blood T-cell immunophenotypes predict early relapse in localized clear cell renal cell carcinoma. Clin Cancer Res.2017; 23(15):4416-4428. Crossref, Medline, Google Scholar Submitted February 4, 2023; accepted June 14, 2023; published 000.s Support: None. Conflict of Interest: The Authors have no potential conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. 22-000427). Data Availability: All data generated or analyzed during this study are included in this published article (and its supplementary information files). © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology20 Jul 2023Editorial Comment Supplementary Materials Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordscytoreduction surgical proceduresneoplasm metastasisrenal cellcarcinomanephrectomyalgorithmsMetricsAuthor Information Rodrigo Rodrigues Pessoa Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Reza Nabavizadeh Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Fernando Quevedo Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota More articles by this author Daniel D. Joyce Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Christine M. Lohse Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota More articles by this author Vidit Sharma Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Brian A. Costello Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota More articles by this author Stephen A. Boorjian Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author R. Houston Thompson Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author Bradley C. Leibovich Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author John C. Cheville Department of Laboratory Medicine and Pathology, Mayo Clinic,Rochester, Minnesota *Correspondence: Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 telephone: 507-266-0686; E-mail Address: [email protected] More articles by this author Expand All Submitted February 4, 2023; accepted June 14, 2023; published 000.s Support: None. Conflict of Interest: The Authors have no potential conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. 22-000427). Data Availability: All data generated or analyzed during this study are included in this published article (and its supplementary information files). Advertisement PDF downloadLoading ...