Unclassified Renal Cell Carcinoma: Impact on Survival Following Nephrectomy
Received 14 October 2009; accepted 22 December 2009. published online 10 March 2010. Corrected Proof
Objectives
To evaluate the impact of the category of unclassified renal cell carcinoma (URCC) on survival following nephrectomy.
Methods
Patients with clear cell RCC (ccRCC, n = 3048) and URCC (n = 38) were identified. Patients with URCC were matched 4:1 with ccRCC patients based on year of surgery, symptoms at presentation, tumor size, stage, regional lymph node involvement, metastases, grade, coagulative tumor necrosis, and sarcomatoid differentiation. Survival was estimated using the Kaplan–Meier method and compared between ccRCC and URCC patients using log-rank tests.
Results
Patients with URCC were more likely to have regional lymph node involvement (P <.001), higher grade (P <.001), tumor necrosis (P <.001), and sarcomatoid differentiation (P <.001) as compared to patients with ccRCC. Overall survival was not significantly different between URCC and ccRCC patients in either the unmatched (P = .337) or matched (P = .345) cohorts. Cancer-specific survival was significantly worse for URCC patients compared with unmatched ccRCC patients (P = .020). However, this difference was not statistically significant when the URCC patients were compared with the matched cohort (P = .688). Distant metastases-free survival was somewhat worse for M0 URCC patients compared with unmatched M0 ccRCC patients (P = .063), but not in the matched cohort (P = .788).
Conclusions
Although URCC is more likely to present with advanced clinicopathologic features compared with ccRCC, no statistically significant differences in outcome were noted after adjusting for these features in a matched analysis.
aDepartment of Urology, Mayo Clinic, Rochester, Minnesota
bDepartment of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
cDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
Reprint requests: Bradley C. Leibovich, M.D., Department of Urology, Mayo Clinic, Rochester, MN 55905
ABSTRACT