Renal cell carcinoma in patients with end-stage renal disease: relationship between histological type and duration of dialysis.
OBJECTIVE
To evaluate the clinical outcomes and histological types of renal cell carcinoma (RCC) arising in patients with end-stage renal disease (ESRD), and to analyse the relationship of histopathological features with the duration of dialysis.


METHODS
Clinical characteristics and outcomes of 34 patients who had a radical nephrectomy for RCC arising in ESRD between November 1994 and June 2008 were investigated. Archive paraffin-embedded tissue specimens obtained from 27 patients were histochemically and immunohistochemically analysed to determine the histopathological type.


RESULTS
There was one death from cancer and one patient with local progression within a median observation period of 29.5 months. Acquired cystic disease (ACD)-associated RCC, clear cell-papillary RCC, mucinous tubular and spindle-cell carcinoma, and Xp11.2 translocation/TFE3 gene fusion were identified in eight, two, three and one patient, respectively. Conventional clear-cell RCC was the predominant histological type (nine of 15) in patients with a duration of dialysis of <10 years, while ACD-associated RCC was predominant (seven of 12) in those with dialysis for > or =10 years. Sarcomatoid foci were identified in three patients with dialysis for > or =10 years. Papillary adenoma was microscopically identified as a satellite tumour in 10 patients.


CONCLUSIONS
The spectrum of histological types of RCCs arising in ESRD is distinct from that of sporadic RCCs. Patients with a longer duration of dialysis should have particular attention for progression and metastasis. Immunohistochemical profiling is efficient in the histological classification of RCCs arising in ESRD, although knowledge about genetic changes remains to be accumulated.
Nouh
Mohammed A A M
MA
Department of Urology, Kagawa University Faculty of Medicine, Kagawa, Japan.
Kuroda
Naoto
N
Yamashita
Motoki
M
Hayashida
Yushi
Y
Yano
Toshifumi
T
Minakuchi
Jun
J
Taniguchi
Susumu
S
Nomura
Isaku
I
Inui
Masashi
M
Sugimoto
Mikio
M
Kakehi
Yoshiyuki
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000473:pathology* / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D007680:Kidney Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D006435:Renal Dialysis; D013997:Time Factors