Comparison of type I and II papillary renal cell carcinoma (RCC) and clear cell RCC

Abstract

OBJECTIVE To compare the pathological features of clear cell renal cell carcinoma (ccRCC) with papillary RCC (pRCC) and further differentiate type I and II pRCC as independent prognosticators for survival. PATIENTS AND METHODS From September 1994 to February 2007 557 RCCs were treated and reviewed. All patients underwent radical nephrectomy or nephron‐sparing surgery. We reviewed patient data and correlated RCC subtypes to tumour size, pathological stage, nuclear grade, and 5‐year cancer‐specific survival (CSS). pRCC was re‐evaluated in to type I and II. The 2002 Tumour‐Node‐Metastasis and Fuhrman classifications were used. RESULTS In all, 391 (70%) patients had ccRCC, 96 (17%) had pRCC, 34 (6%) had chromophobe RCC, seven (1%) had ductus Bellini RCC and 29 (5%) had unclassified RCC. Upon re‐evaluation 34 patients had type I pRCC and 62 had type II. The pRCCs were significantly smaller than the ccRCCs, at a mean (sd) of 4.5 (2.5) cm vs 5 (2.9) cm (P = 0.013), and multifocal (25% vs 12%, P = 0.001). Whereas patients with ccRCC had significantly more primary metastases (12% vs 3%, P = 0.014). The mean (sd) follow‐up was 42.3 (41.4) months. The 5‐year CSS for M0 patients was 84% for ccRCC and 90% for pRCC (P = 0.573). At multivariate analyses predictors for 5‐year CSS were only tumour size (hazard ratio, HR 2.6, P < 0.001), pathological stage (HR 3.9, P < 0.001) and nuclear grade (HR 2.7, P < 0.001). The type I and II pRCCs had significantly different lymphovascular invasion (LVI) and 5‐year CSS rates (94% vs 74%, P = 0.03). CONCLUSIONS The ccRCCs were significantly larger at diagnosis than the pRCCs. The histological subtype (pRCC vs ccRCC) had no impact on the 5‐year CSS in multivariate analyses. The type I and II pRCCs had similar histopathological features except for a significant difference in LVI. However, the 5‐year CSS was significantly different in type I and II pRCC.

Outcome of papillary versus clear cell renal cell carcinoma varies significantly in non-metastatic disease

“…Consequently, we are the first group to present such data. Equal to our results, former studies revealed that pRCC (versus ccRCC) displayed more male patients and lower tumor stages [9,10,[12][13][14][15][22][23][24]. Our results that pRCC harbor more regional lymph node metastasis but less distant metastasis at time of diagnosis are in accordance with previous studies [9,10,12,13,[22][23][24].…”

“…Our results that pRCC harbor more regional lymph node metastasis but less distant metastasis at time of diagnosis are in accordance with previous studies [9,10,12,13,[22][23][24]. Again similar to our data, patients with pRCC type 2 presented with higher tumor stages, higher grades, more regional lymph node metastases, and more distant metastases [4,5,7,16,23,25,26], compared to patients with pRCC type 1. In conclusion, the results are most likely determined by the underlying tumor biology.…”

“…Equal to our results, former studies revealed that pRCC (versus ccRCC) displayed more male patients and lower tumor stages [9,10,[12][13][14][15][22][23][24]. Our results that pRCC harbor more regional lymph node metastasis but less distant metastasis at time of diagnosis are in accordance with previous studies [9,10,12,13,[22][23][24]. Again similar to our data, patients with pRCC type 2 presented with higher tumor stages, higher grades, more regional lymph node metastases, and more distant metastases [4,5,7,16,23,25,26], compared to patients with pRCC type 1.…”

HMGB1 and HMGB2 Expression Patterns in Human Papillary Renal Cancers

“…Papillary renal cell carcinomas are further differentiated into type 1 and type 2 with the latter having significant lymphovascular invasion and poorer prognosis [18]. Clearly, the two cases in the present study seem to be type 1 papillary renal cell carcinomas with their histology.…”

“…Papillary renal cell carcinomas are generally smaller and have fewer metastases at diagnosis compared with clear cell renal cell carcinomas with similar or favorable cancer specific survivals [17,18]. Papillary renal cell carcinomas are further differentiated into type 1 and type 2 with the latter having significant lymphovascular invasion and poorer prognosis [18].…”