Histological subtype is an independent predictor of outcome for patients with renal cell carcinoma.
OBJECTIVE
There are significant differences in clinicopathological features among renal cell carcinoma histological subtypes but controversy exists regarding the independent impact of histological subtype on patient outcome after nephrectomy. We examined the significance of histological subtype on progression to distant metastasis and cancer specific death after nephrectomy.


METHODS
In a retrospective review of our institutional nephrectomy registry we identified 3,062 patients treated surgically for clear cell, papillary or chromophobe renal cell carcinoma between 1970 and 2003.


RESULTS
We identified 2,466 patients (80.5%) with clear cell, 438 (14.3%) with papillary and 158 (5.2%) with chromophobe renal cell carcinoma. There were significant differences in age at surgery, gender, symptoms at presentation, tumor size, stage and grade, tumor necrosis, sarcomatoid differentiation and multifocality among the 3 renal cell carcinoma subtypes (p <0.01 for all). A significant difference in metastasis-free and cancer specific survival existed between patients with clear cell renal cell carcinoma and the 2 other subtypes, although no significant difference in these outcomes was identified between patients with the papillary and chromophobe subtypes. The clear cell renal cell carcinoma subtype remained a significant predictor of metastasis (HR 2.76, 95% CI 2.05-3.73) and cancer specific death (HR 1.77, 95% CI 1.38-2.26, each p <0.001) after multivariate adjustment for the features listed above.


CONCLUSIONS
Histological subtype is an independent predictor of progression to distant metastasis and cancer specific death in patients with renal cell carcinoma.
Leibovich
Bradley C
BC
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA. leibovich.bradley@mayo.edu
Lohse
Christine M
CM
Crispen
Paul L
PL
Boorjian
Stephen A
SA
Thompson
R Houston
RH
Blute
Michael L
ML
Cheville
John C
JC
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000145:classification / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000145:classification / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies