title: Does chromophobe renal cell carcinoma have better survival than clear cell renal cell carcinoma? A clinical-based cohort study and meta-analysis.
abstract: BACKGROUND
  It is controversial whether chromophobe renal cell carcinoma (chRCC) or clear cell renal cell carcinoma (ccRCC) is associated with better survival. We conducted a clinical-based cohort study and meta-analysis to evaluate the prognostic role of histology between chRCC and ccRCC.
  
  
  METHODS
  A cohort of 1540 patients (166 with chRCC and 1374 with ccRCC) were selected from Sun Yat-sen University and The Cancer Genome Atlas databases. The clinicopathological parameters and overall survival (OS) were compared between patients with chRCC and those with ccRCC. For the meta-analysis, we searched the PubMed, Cochrane Library, and Ovid databases for studies comparing OS or cancer-specific survival (CSS) between chRCC and ccRCC.
  
  
  RESULTS
  The cohort study revealed that patients with chRCC were younger (median 52 vs. 55 years, P < 0.001), were more commonly female (47.0 vs. 33.0%, P < 0.001), and had a larger tumor size (mean 7.1 vs. 5.9 cm, P < 0.001), and they had a lower stage compared with those with ccRCC. Five-year OS rates for chRCC and ccRCC were 90.3 and 75.3%, respectively (P < 0.001). We found significantly better survival for chRCC in stratification analysis by age, sex, tumor size, and stage. Similar results were observed on both univariate [hazard ratio (HR), 0.30; 95% confidence interval (CI) 0.16-0.55, P < 0.001] and multivariate analyses (HR 0.42; 95% CI 0.23-0.79, P = 0.006). Ten studies were included in our meta-analysis. Eight of them provided data on univariate analysis. The pooled HR was statistically significant for OS (pooled HR 0.49; 95% CI 0.30-0.79, P = 0.004) and CSS (pooled HR 0.49; 95% CI 0.37-0.64, P < 0.001). Seven studies reported the HR on multivariate analysis. The pooled HR was also statistically significant for OS (pooled HR 0.63; 95% CI 0.51-0.77, P < 0.001) and CSS (pooled HR 0.72; 95 % CI 0.57-0.90, P = 0.003). These data indicate that patients with chRCC had better outcomes than those with ccRCC.
  
  
  CONCLUSIONS
  Our large cohort study and meta-analysis confirmed that chRCC had better survival than ccRCC.
authors.affiliation: Department of Urology, First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhong Shan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China.|Department of Urology, Meizhou People's Hospital, No. 63, Huang Tang Road, Meizhou, 514031, Guangdong, People's Republic of China.
authors.forename: Hui-Ming
authors.initials: HM
authors.lastname: Jiang
authors.affiliation: Department of Urology, First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhong Shan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China.
authors.forename: Jin-Huan
authors.initials: JH
authors.lastname: Wei
authors.affiliation: Department of Urology, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
authors.forename: Zhi-Ling
authors.initials: ZL
authors.lastname: Zhang
authors.affiliation: Department of Urology, First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhong Shan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Fang
authors.affiliation: Department of Urology, First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhong Shan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China.
authors.forename: Bang-Fen
authors.initials: BF
authors.lastname: Zhou
authors.affiliation: Department of Urology, First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhong Shan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China.
authors.forename: Zhen-Hua
authors.initials: ZH
authors.lastname: Chen
authors.affiliation: Department of Urology, First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhong Shan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Urology, First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhong Shan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China.
authors.forename: Bing
authors.initials: B
authors.lastname: Liao
authors.affiliation: Department of Urology, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
authors.forename: Fang-Jian
authors.initials: FJ
authors.lastname: Zhou
authors.affiliation: Department of Urology, First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhong Shan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China. luojunh@mail.sysu.edu.cn.
authors.forename: Jun-Hang
authors.initials: JH
authors.lastname: Luo
authors.affiliation: Department of Urology, First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhong Shan 2nd Road, Guangzhou, 510080, Guangdong, People's Republic of China. chenw3@mail.sysu.edu.cn.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D014943:Global Health; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D009392:Nephrectomy; D011379:Prognosis; D015996:Survival Rate / Q000639:trends
keywords: Chromophobe renal cell carcinoma; Clear cell renal cell carcinoma; Survival