title: Prognostic factors in a large multi-institutional series of papillary renal cell carcinoma.
abstract: OBJECTIVE
  To investigate cancer-related outcomes and prognostic factors of papillary renal cell carcinoma (pRCC) in a large multicentre data set. Oncological outcome and prognostic factors of pRCC have been limitedly evaluated in comparison with the most common RCC subtype, clear cell RCC.
  
  
  METHODS
  From a multicentre retrospective database, including 5463 patients who were surgically treated for RCC at 16 Italian academic centres between 1995 and 2007, 577 patients with pRCC were identified. Univariable and multivariable Cox regression models were performed to identify prognostic factors predictive of recurrence-free survival (RFS) and cancer-specific survival (CSS) after surgery.
  
  
  RESULTS
  At a median (interquartile range) follow-up of 39.2 (21.7-72) months, 81 (14%) patients had experienced disease progression and 63 (11%) patients had died from disease; the 5-year RFS estimate was 85.5%. In multivariable analysis, pathological N stage (pooled P < 0.001), M stage (hazard ratio, 2.9; P= 0.007) and Fuhrman nuclear grade (pooled P= 0.039) were all independent predictors of RFS; the 5-year CSS estimate was 87.9%. In Cox multivariable analysis, an independent predictive role was reconfirmed for mode of presentation (pooled P= 0.038), pathological N stage (pooled P < 0.001), M stage (hazard ratio, 2.4; P= 0.049) and Fuhrman nuclear grade (pooled P= 0.037).
  
  
  CONCLUSIONS
  Patients with pRCC have a low risk of tumour recurrence and cancer-related death after surgery. Fuhrman nuclear grade was found to be a stronger predictor of both RFS and CSS, whereas only a non-statistically significant trend was found for the 2009 pathological T stage.
authors.affiliation: University of Perugia - Urology and Andrology, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zucchi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Costantini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Carmignani
authors.forename: Sergio
authors.initials: S
authors.lastname: Cosciani Cunico
authors.forename: Dario
authors.initials: D
authors.lastname: Fontana
authors.forename: Nicola
authors.initials: N
authors.lastname: Longo
authors.forename: Guido
authors.initials: G
authors.lastname: Martignoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Minervini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
authors.forename: Massimo
authors.initials: M
authors.lastname: Porena
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
authors.forename: Alchiede
authors.initials: A
authors.lastname: Simonato
authors.forename: Salvatore
authors.initials: S
authors.lastname: Siracusano
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
mesh_terms: D000046:Academic Medical Centers; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors