Advertisement

Long-Term Outcomes of Patients With Low Grade Cystic Renal Epithelial Neoplasms

      Abstract

      Objective

      To report on the long-term oncologic outcomes of 3 subtypes of low grade cystic renal epithelial neoplasms—multilocular cystic neoplasm of low malignant potential (MCLMP), cystic clear cell RCC (ccRCC), and cystic clear cell papillary RCC (ccpRCC), following 2016 reorganization by the World Health Organization.

      Materials and Methods

      A total of 3865 patients underwent radical or partial nephrectomy for unilateral, sporadic ccRCC between 1970 and 2010, of which 145 had previously been classified as cystic ccRCC. One genitourinary pathologist, blinded to outcome, rereviewed and reclassified the specimens by 2016 WHO criteria. Oncologic outcomes were estimated using the Kaplan-Meier method.

      Results

      Of 145 specimens, 18 (12%) were classified as MCLMP, 95 (66%) cystic ccRCC, and 32 (22%) cystic ccpRCC. Those with MCLMP were more likely female (61% vs 29% vs 31%, P = .03) with larger tumors (median 4.6 cm vs 3.0 cm vs 2.3 cm, P = .02) compared to those with cystic ccRCC and cystic ccpRCC, respectively. Only 2% of cystic ccRCC had tumor necrosis or grade 3 nucleoli present. Median follow-up for survivors was 10.3 years (interquartile range 7.4-14.9). Overall, 1 MCLMP, 5 cystic ccRCC, and 4 ccpRCC recurred during follow-up. Ten- and 20-year cancer-specific survival was 100% across all subtypes.

      Conclusion

      In a large cohort of patients previously classified as cystic ccRCC with pathologic rereview and long-term follow-up, we noted that MCLMP is the least common subtype of low grade cystic renal epithelial neoplasms. Regardless, all subtypes are associated with an excellent long-term prognosis following surgical resection.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2019.
        CA Cancer J Clin. 2019; 69: 7-34
        • Cheville J.C.
        • Lohse C.M.
        • Zincke H.
        • Weaver A.L.
        • Blute M.L.
        Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma.
        Am J Surg Pathol. 2003; 27: 612-624
        • Srigley J.R.
        • Hutter R.V.
        • Gelb A.B.
        • et al.
        Current prognostic factors–renal cell carcinoma: workgroup No. 4. Union Internationale Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC).
        Cancer. 1997; 80: 994-996
        • Srigley J.R.
        • Delahunt B.
        • Eble J.N.
        • et al.
        The International Society of Urological Pathology (ISUP) vancouver classification of renal neoplasia.
        Am J Surg Pathol. 2013; 37: 1469-1489
        • Aubert S.
        • Zini L.
        • Delomez J.
        • Biserte J.
        • Lemaitre L.
        • Leroy X.
        Cystic renal cell carcinomas in adults. Is preoperative recognition of multilocular cystic renal cell carcinoma possible?.
        J Urol. 2005; 174: 2115-2119
        • Hartman D.S.
        • Davis Jr., C.J.
        • Johns T.
        • Goldman S.M.
        Cystic renal cell carcinoma.
        Urology. 1986; 28: 145-153
      1. World Health Organization Classification of Tumours, Pathology and Genetics, Tumours of the Urinary System and Male Genital Organs.
        (IS I)in: Eble J. Epstein J. World Health Organization Classification of Tumours, Pathology and Genetics, Tumours of the Urinary System and Male Genital Organs. International Agency for Research on Cancer (IARC) Press, Lyon, France2004
        • Corica F.A.
        • Iczkowski K.A.
        • Cheng L.
        • et al.
        Cystic renal cell carcinoma is cured by resection: a study of 24 cases with long-term followup.
        J Urol. 1999; 161: 408-411
        • Han K.R.
        • Janzen N.K.
        • McWhorter V.C.
        • et al.
        Cystic renal cell carcinoma: biology and clinical behavior.
        Urol Oncol. 2004; 22: 410-414
        • Koga S.
        • Nishikido M.
        • Hayashi T.
        • Matsuya F.
        • Saito Y.
        • Kanetake H.
        Outcome of surgery in cystic renal cell carcinoma.
        Urology. 2000; 56: 67-70
        • Nassir A.
        • Jollimore J.
        • Gupta R.
        • Bell D.
        • Norman R.
        Multilocular cystic renal cell carcinoma: a series of 12 cases and review of the literature.
        Urology. 2002; 60: 421-427
        • Donin NM.
        • Mohan S.
        • Pham H.
        • et al.
        Clinicopathologic outcomes of cystic renal cell carcinoma.
        Clin Genitourin Cancer. 2015; 13: 67-70
        • Jhaveri K.
        • Gupta P.
        • Elmi A.
        • et al.
        Cystic renal cell carcinomas: do they grow, metastasize, or recur?.
        Am J Roentgenol. 2013; 201: W292-W296
        • Winters B.R.
        • Gore J.L.
        • Holt S.K.
        • Harper J.D.
        • Lin D.W.
        • Wright J.L.
        Cystic renal cell carcinoma carries an excellent prognosis regardless of tumor size.
        Urol Oncol. 2015; 33 (505.e9-13)
        • Moch H.
        • Cubilla A.L.
        • Humphrey P.A.
        • Reuter V.E.
        • Ulbright T.M.
        The 2016 WHO classification of tumours of the urinary system and male genital organs-part A: renal, penile, and testicular tumours.
        Eur Urol. 2016; 70: 93-105
        • Brimo F.
        • Atallah C.
        • Li G.
        • Srigley J.R.
        Cystic clear cell papillary renal cell carcinoma: is it related to multilocular clear cell cystic neoplasm of low malignant potential?.
        Histopathology. 2016; 68: 666-672
        • Raspollini M.R.
        • Montagnani I.
        • Montironi R.
        • et al.
        A contemporary series of renal masses with emphasis on recently recognized entities and tumors of low malignant potential: a report based on 624 consecutive tumors from a single tertiary center.
        Pathol Res Pract. 2017; 213: 804-808
        • Webster W.S.
        • Thompson R.H.
        • Cheville J.C.
        • Lohse C.M.
        • Blute M.L.
        • Leibovich B.C.
        Surgical resection provides excellent outcomes for patients with cystic clear cell renal cell carcinoma.
        Urology. 2007; 70 (discussion 904): 900-904
        • Amin M.B.
        • Greene F.L.
        • Edge S.B.
        • et al.
        The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging.
        CA Cancer J Clin. 2017; 67: 93-99
        • Sengupta S.
        • Lohse CM.
        • Leibovich BC.
        • et al.
        Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness.
        Cancer. 2005; 104: 511-520
        • Suzigan S.
        • Lopez-Beltran A.
        • Montironi R.
        • et al.
        Multilocular cystic renal cell carcinoma: a report of 45 cases of a kidney tumor of low malignant potential.
        Am J Clin Pathol. 2006; 125: 217-222
        • Bhatt J.R.
        • Jewett M.A.
        • Richard P.O.
        • et al.
        Multilocular cystic renal cell carcinoma: pathological T staging makes no difference to favorable outcomes and should be reclassified.
        J Urol. 2016; 196: 1350-1355
        • Li T.
        • Chen J.
        • Jiang Y.
        • et al.
        Multilocular cystic renal cell neoplasm of low malignant potential: a series of 76 cases.
        Clin Genitourin Cancer. 2016; 14: e553-e557
        • Wilkinson C.
        • Palit V.
        • Bardapure M.
        • et al.
        Adult multilocular cystic nephroma: report of six cases with clinical, radio-pathologic correlation and review of literature.
        Urol Ann. 2013; 5: 13-17
        • Lam J.S.
        • Shvarts O.
        • Said J.W.
        • et al.
        Clinicopathologic and molecular correlations of necrosis in the primary tumor of patients with renal cell carcinoma.
        Cancer. 2005; 103: 2517-2525
        • You D.
        • Shim M.
        • Jeong I.G.
        • et al.
        Multilocular cystic renal cell carcinoma: clinicopathological features and preoperative prediction using multiphase computed tomography.
        BJU Int. 2011; 108: 1444-1449
        • Park J.J.
        • Jeong B.C.
        • Kim C.K.
        • et al.
        Postoperative outcome of cystic renal cell carcinoma defined on preoperative imaging: a retrospective study.
        J Urol. 2017; 197: 991-997
        • Tretiakova M.
        • Mehta V.
        • Kocherginsky M.
        • et al.
        Predominantly cystic clear cell renal cell carcinoma and multilocular cystic renal neoplasm of low malignant potential form a low-grade spectrum.
        Virchows Arch. 2018; 473: 85-93