The Impact of Histological Variants on Oncological Outcomes After Surgical Resection of a Nonmetastatic Renal Cell Carcinoma with Tumor Thrombus: A Multi-institutional Study

被引：1

作者：

Fleury, Raphael ^{[1
]}

Bertail, Theophile ^{[1
]}

Bensalah, Karim ^{[1
,2
]}

Bernhard, Jean-Christophe ^{[3
]}

Audent, Francois ^{[4
]}

Waeckel, Thibaut ^{[5
]}

Parier, Bastien ^{[6
]}

Champy, Cecile ^{[7
]}

Olivier, Jonathan ^{[8
]}

Doumerc, Nicolas ^{[9
]}

Tricard, Thibault ^{[10
]}

Branger, Nicolas ^{[11
]}

Bruyere, Franck ^{[12
]}

Neuville, Paul ^{[13
]}

Surlemont, Louis ^{[14
]}

Long, Jean Alexandre ^{[15
]}

Fontenil, Alexis ^{[16
]}

Vallee, Maxime ^{[17
]}

Roupret, Morgan ^{[18
]}

Boissier, Romain ^{[19
]}

Patard, Jean Jacques ^{[20
]}

Durand, Mathieu ^{[21
]}

Ouzaid, Idir ^{[22
]}

Rouget, Benjamin ^{[23
]}

Durand, Xavier ^{[24
]}

Joncour, Charlotte ^{[25
]}

Belas, Olivier ^{[26
]}

Gomez, Florie Denise ^{[27
]}

Bigot, Pierre ^{[28
]}

Khene, Zine-Eddine ^{[1
,2
]}

机构：

[1] Ctr Hosp Univ Rennes, Dept Urol, Rennes, France

[2] Univ Rennes 1, LTSI, Inserm U1099, Rennes, France

[3] Ctr Hosp Univ Bordeaux, Dept Urol, Bordeaux, France

[4] Hop Europeen Georges Pompidou, APHP, Dept Urol, Paris, France

[5] Ctr Hosp Univ Caen, Dept Urol, Caen, France

[6] Hop Bicetre, APHP, Paris, France

[7] Ctr Hosp Henri Mondor, APHP, Dept Urol, Creteil, France

[8] Ctr Hosp Univ Lille, Dept Urol, Lille, France

[9] Ctr Hosp Univ Rangueil, Dept Urol, Toulouse, France

[10] Ctr Hosp Univ Strasbourg, Dept Urol, Strasbourg, France

[11] Inst Paoli Calmettes Marseille, Dept Urol, Marseille, France

[12] Ctr Hosp Univ Tours, Dept Urol, Tours, France

[13] Hosp Civils Lyon, Dept Urol, Lyon, France

[14] Ctr Hosp Univ Rouen, Dept Urol, Rouen, France

[15] Ctr Hosp Univ Grenoble, Dept Urol, Grenoble, France

[16] Ctr Hosp Univ Nimes, Dept Urol, Nimes, France

[17] Ctr Hosp Univ Poitiers, Dept Urol, Poitiers, France

[18] Hop La Pitie Salpetriere, APHP, Dept Urol, Paris, France

[19] Hop Conception, APHM, Dept Urol, Marseille, France

[20] Ctr Hosp Mt de Marsan, Dept Urol, Mt De Marsan, France

[21] Ctr Hosp Univ Nice, Dept Urol, Nice, France

[22] Hop Bichat Claude Bernard, APHP, Dept Urol, Paris, France

[23] Ctr Hosp Libourne, Dept Urol, Libourne, France

[24] Hop Prive St Joseph, Dept Urol, Paris, France

[25] Ctr Hosp Univ Reims, Dept Urol, Reims, France

[26] Pole Sante Sud Mans, Dept Urol, Le Mans, France

[27] Hop Tenon, APHP, Dept Urol, Paris, France

[28] Ctr Hosp Univ Angers, Dept Urol, Angers, France

来源：

EUROPEAN UROLOGY OPEN SCIENCE | 2024年 / 62卷

关键词：

Kidney cancer; Thrombus; Renal cell carcinoma; Histological variants; Prognosis; Recurrence; CANCER; SURVIVAL; NEPHRECTOMY; MULTICENTER; MANAGEMENT; RECURRENCE; SURGERY; SUBTYPE; RISK;

D O I：

10.1016/j.euros.2024.02.015

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background: There is no definitive evidence of the prognosis impact of histological variants (HVs) in patients who undergo surgical resection of a nonmetastatic renal cell carcinoma (nm-RCC) with venous tumor thrombus (TT). Objective: To investigate the impact of HVs on the prognosis of patients with nmRCC with TT after radical surgery. Design, setting, and participants: Patients who underwent radical nephrectomy with the removal of the venous TT for an nm-RCC were included in a retrospective study. Outcome measurements and statistical analysis: Three groups were identified: clear cell (ccRCC), papillary (pRCC), and chromophobe (chRCC) RCC. The primary outcome measures (disease -free and overall survival [OS]) were assessed using the Kaplan -Meier method and compared using the log -rank test. Univariate and multivariate Cox proportional hazard models were used to study the impact of HVs on survival. Results and limitations: A total of 873 patients were included. The histological subtypes were distributed as follows: ccRCC in 780 cases, pRCC in 58 cases, and chRCC in 35 cases. At the time of data analysis, 612 patients were recurrence free and 228 had died. A survival analysis revealed significant differences in both OS and recurrence -free survival across histological subtypes, with the poorest outcomes observed in pRCC patients (p < 0.05). In a multivariable analysis, pRCC was independently associated with worse disease -free survival and OS (hazard ratio [HR]: 1.71; p = 0.01 and HR: 1.24; p = 0.04), while chRCC was associated with more favorable outcomes than ccRCC (HR: 0.05; p < 0.001 and HR: 0.02; p < 0.001). A limitation of the study is its retrospective nature. Conclusions: In this multicentric series, HVs appeared to impact the medium -term oncological prognosis of kidney cancer with TT. Patient summary: This study investigated the differences in oncological outcomes among histological variants (clear cell, papillary, and chromophobe) in a cohort of nonmetastatic renal cell carcinoma patients with venous tumor thrombus extension. We observed that these histological variants within this specific subgroup exhibit distinct outcomes, with papillary renal cell carcinoma being associated with the worst prognosis. (c) 2024 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

引用

页码：123 / 130

页数：8

共 20 条

[1] Risk factors for recurrence after surgery in non-metastatic RCC with thrombus: a contemporary multicentre analysis [J].