title: Histologic tumor necrosis is an independent prognostic indicator for clear cell and papillary renal cell carcinoma.
abstract: Histologic tumor necrosis (TN) has been reported to indicate a poor prognosis for different human cancers. In papillary renal cell carcinoma (RCC), data regarding the prognostic impact of TN are conflicting. We retrospectively studied the pathology records of 2,333 consecutive patients who underwent nephrectomy from 1984 to 2006 at a single tertiary academic center. In multivariate analyses regarding clear cell RCC, the presence of histologic TN was an independent negative prognostic factor for metastasis-free (hazard ratio [HR], 2.32; confidence interval [CI], 1.86-2.9; P < .001) and overall (HR, 1.52; CI, 1.31-1.76; P < .001) survival. Regarding papillary RCC, the presence of histologic TN represented an independent predictor of metastasis-free (HR, 5.22; CI, 2.2-12.5; P < .001) and overall (HR, 1.69; CI, 1.11-2.58; P = .015) survival. Our findings suggest that the presence of TN is an independent predictor of clinical outcome in clear cell and papillary RCC. Thus, histologic TN might be a reliable prognostic indicator and should, therefore, routinely be examined during pathologic analysis of RCC specimens.
authors.affiliation: Department of Urology, Medical University of Graz, Auenbruggerplatz 5/6, Graz, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Pichler
authors.forename: Georg C
authors.initials: GC
authors.lastname: Hutterer
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Chromecki
authors.forename: Johanna
authors.initials: J
authors.lastname: Jesche
authors.forename: Karin
authors.initials: K
authors.lastname: Kampel-Kettner
authors.forename: Peter
authors.initials: P
authors.lastname: Rehak
authors.forename: Karl
authors.initials: K
authors.lastname: Pummer
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
mesh_terms: D000368:Aged; D001317:Austria / Q000453:epidemiology; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate