Papillary type 2 versus clear cell renal cell carcinoma: Survival outcomes.
OBJECTIVE
To compare the cancer specific survival (CSS) between p2-RCC and a Propensity Score Matched (PSM) cohort of cc-RCC patients.


METHODS
Fifty-five (4.6%) patients with p2-RCC and 920 cc-RCC patients were identified within a prospectively maintained institutional dataset of 1205 histologically proved RCC patients treated with either RN or PN. Univariable and multivariable Cox regression analyses were used to identify predictors of CSS after surgical treatment. A 1:2 PSM analysis based on independent predictors of oncologic outcomes was employed and CSS was compared between PSM selected cc-RCC patients using Kaplan-Meier and Cox regression analysis.


RESULTS
Overall, 55 (4.6%) p2-RCC and 920 (76.3%) cc-RCC patients were selected from the database; p2-RCC were significantly larger (p = 0.001), more frequently locally advanced (p < 0.001) and node positive (p < 0.001) and had significantly higher Fuhrman grade (p < 0.001) than cc-RCC. On multivariable Cox regression analysis age (p = 0.025), histologic subtype (p = 0.029), pN stage (p = 0.006), size, pT stage, cM stage, sarcomatoid features and Fuhrman grade (all p < 0.001) were independent predictors of CSS. After applying the PSM, 82 cc-RCC selected cases were comparable to 41 p2-RCC for age (p = 0.81), tumor size (p = 0.39), pT (p = 1.00) and pN (p = 0.62) stages, cM stage (p = 0.71) and Fuhrman grade (p = 1). In this PSM cohort, 5 yr CSS was significantly lower in the p2-RCC (63% vs 72.4%; p = 0.047). At multivariable Cox analysis p2 histology was an independent predictor of CSM (HR 2.46, 95% CI 1.04-5.83; p = 0.041).


CONCLUSIONS
We confirmed the tendency of p2-RCC to present as locally advanced and metastatic disease more frequently than cc-RCC and demonstrated p2-RCC histology as an independent predictor of worse oncologic outcomes.
Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. Electronic address: puldet@gmail.com.
G
G
Simone
Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
G
G
Tuderti
Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
M
M
Ferriero
Department of Urology, "Campus Biomedico" University of Rome, Italy.
R
R
Papalia
Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
L
L
Misuraca
Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
F
F
Minisola
Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
M
M
Costantini
Department of Urology, "Campus Biomedico" University of Rome, Italy.
R
R
Mastroianni
Department of Pathology, "Regina Elena" National Cancer Institute, Rome, Italy.
S
S
Sentinelli
Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
S
S
Guaglianone
Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
M
M
Gallucci
D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000401:mortality* / Q000473:pathology; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models
Histologic subtypes; Papillary; Prognosis; Renal cell carcinoma