Effect of Collecting Duct Histology on Renal Cell Cancer Outcome

Abstract

Purpose-Collecting duct renal cell carcinoma (CDRCC) is a rare entity. Recent surgical series on CDRCC presented conflicting results. In this study, we use a United States population-based dataset to describe the survival experience of patients with CRDCC to those with clear cell renal cell carcinomas (CCRCC).Materials and Methods-Cases of CDRCC and CCRCC were identified from the SEER Program (2001Program ( -2005. Demographic and pathologic characteristics at time of diagnosis were compared. Differences in disease-specific survival were compared with univariate and multivariate Cox regression analysis.Results-A total of 160 cases of CDRCC were present in the SEER database from 2001-2005. Over that time period, 33,252 CCRCC cases were diagnosed. CDRCC was more common in AfricanAmericans vs. Caucasians (23% vs. 9%, p<0.001). CDRCC were more commonly T3+ vs. T2/T1 (33% vs. 18%, p<0.001) and metastatic vs. regional/local (28% vs. 17%, p=0.001). Nephrectomy rates were similar (84% and 78%, p=0.06). The 3-year disease-specific survival (DSS) rates were 58% for CDRCC and 79% for CCRCC. In multivariate analysis, there was an increased mortality risk for patients with CDRCC compared to CCRCC (HR 2.42, 95% CI 1.72 -3.39, p = 0.001).Conclusions-Compared to CCRCC, patients with CDRCC present at higher stage and more often occurs in African-Americans. Even after adjusting for demographic, surgical and pathologic factors, the DSS is significantly worse for those with CDRCC compared to CCRCC. Further research into the biology of this rare tumor is required to explain these results.

Management of Renal Collecting Duct Carcinoma: A Systematic Review and the McMaster Experience

“…All patients were symptomatic at presentation, with classic symptoms of flank pain or gross hematuria 3 . Presence of flank pain at cdc presentation is ascribed to the infiltrative nature and regional lymphadenopathy of even small cdc tumours, such as the 3.6-cm Patients were diagnosed in about their 6th decade and had advanced staging at presentation, as in other reported series 1 . Interestingly, 2 patients in our series had adrenal metastases, a site not commonly reported for cdc metastasis 3 .…”

“…Recently published series [1][2][3] and conventional secondary sources 9 do not provide direction on the appropriate management of cdc. It is for that purpose that we report the results of a systematic review addressing the management of cdc.…”

“…Localized cdc is an uncommon entity [1][2][3] . No studies encountered in our review addressed the management of localized cdc.…”

“…Surgery Almost all reported patients with cdc have undergone surgery [1][2][3]11 and are diagnosed with cdc only after a histopathology examination. To illustrate this point, 87% of patients in the study by Oudard et al underwent prior cytoreductive nephrectomy.…”

“…The U.S. population-based series by Wright et al characterized cdc epidemiology in North America (Table i) 1 . Compared with clear cell rcc, cdc is more common in African American and male patients.…”