title: Determinants and prognostic implications of malignant ascites in metastatic papillary renal cancer.
abstract: To describe the incidence of ascites in metastatic papillary renal cell cancer (pRCC), identify the factors associated with its development and evaluate its prognostic effect on the survival of these patients.
  
  
  
  A retrospective evaluation of the medical records of patients with metastatic pRCC seen at National Cancer Institute (2000-2014) was undertaken. Logistic regression to identify predictors of the development of malignant ascites and Kaplan-Meier analysis to estimate survival was done.
  
  
  
  Overall, 106 consecutive patients with metastatic pRCC were identified; sufficient data were available in 100 patients to enable assessment of ascites. Further, 20% had evidence of malignant ascites. Median age at diagnosis of ascites was 48.0 years (26.1-76.6 years) and median time to development of ascites from initial diagnosis of metastatic disease was 16.0 (0-73.3) months. There was no significant difference in the incidence of ascites between patients with hereditary and sporadic pRCC (P = 0.803) or among patients with different subtypes of pRCC (P = 0.456). Elevated platelet-lymphocyte ratio predicted development of malignant ascites in our cohort (P = 0.009). Median overall survival was shorter for patients who developed ascites [25.0 (10.2-39.8) months] compared with patients who did not develop this complication [42.5 (30.5-54.4) months, P = 0.041].
  
  
  
  To our knowledge, this is the first systematic evaluation of the incidence, predictors, and prognostic effect of ascites in metastatic pRCC. Malignant ascites is a common manifestation of metastatic pRCC and is associated with a shorter overall survival. An elevated platelet-lymphocyte ratio predicts a higher risk of developing malignant ascites.
authors.affiliation: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD. Electronic address: abhinavsidana01@gmail.com.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Sidana
authors.affiliation: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Meet
authors.initials: M
authors.lastname: Kadakia
authors.affiliation: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Friend
authors.affiliation: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Louis S
authors.initials: LS
authors.lastname: Krane
authors.affiliation: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Daniel
authors.initials: D
authors.lastname: Su
authors.affiliation: Laboratory of Pathology, National Cancer Institute, Bethesda, MD.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Merino
authors.affiliation: Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
authors.forename: Ramaprasad
authors.initials: R
authors.lastname: Srinivasan
mesh_terms: D000328:Adult; D000368:Aged; D001201:Ascites / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D002292:Carcinoma, Renal Cell / Q000097:blood / Q000401:mortality* / Q000556:secondary; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000097:blood / Q000401:mortality* / Q000556:secondary; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
keywords: Malignant ascites; Metastasis; Papillary renal cell cancer; Peritoneal carcinomatosis; Platelet-lymphocyte ratio; Survival