Abstract
BackgroundTo compare the clinicopathologic parameters and oncologic outcomes between type 1 and type 2 papillary renal cell carcinoma (PRCC).MethodsThis study was approved by the review board (NO.XYFY2019-KL032–01). Between 2007 and 2018, 52 consecutive patients who underwent surgery at a single tertiary referral hospital were included. Clinicopathologic and survival data were collected and entered into a database. The Kaplan-Meier method, and univariate and multivariate Cox proportional hazard regression analyses were performed to estimate progression-free survival (PFS) and cancer-specific survival (CSS).ResultsOf the 52 patients, 24 (46.2%) were diagnosed with type 1 PRCC, and 28 (53.8%) had type 2 PRCC. The mean tumor size was 4.8 ± 2.5 cm. The two subtypes displayed different morphological features: foamy macrophages were more common in type 1 PRCC, while eosinophils and microvascular angiolymphatic invasion were more frequent in type 2 PRCC. Type 2 cases showed higher tumor stage and World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade than type 1 cases (T3-T4: 43% vs 17%, P = 0.041; G3-G4: 43% vs 8%, P = 0.005). In univariate analysis, type 2 PRCC had a lower probability for PFS and CSS than patients with type 1 PRCC (P = 0.016, P = 0.049, log-rank test, respectively). In multivariate analysis, only WHO/ISUP grade (HR 11.289, 95% CI 2.303–55.329, P = 0.003) and tumor size (HR 1.244, 95% CI 1.034–1.496, P = 0.021) were significantly associated with PFS.ConclusionsPRCC subtype displayed different morphological features: foamy macrophages, eosinophils and microvascular angiolymphatic invasion are pathologic features that may aid in the distinction of the two subtypes. Histologic subtype of PRCC is not an independent prognostic factor and only WHO/ISUP grade and tumor size were independent predictors for PFS.
Highlights
To compare the clinicopathologic parameters and oncologic outcomes between type 1 and type 2 papillary renal cell carcinoma (PRCC)
Eosinophils and microvascular angiolymphatic invasion were more frequent in type 2 PRCC (P = 0.012 and P = 0.028, respectively)
We found that aggregates of foamy macrophages in the background stroma were common (69.2% of cases) and presence of foamy macrophages was less frequent in type 2 PRCC (57.1%) than type 1 PRCC (83.3%)
Summary
To compare the clinicopathologic parameters and oncologic outcomes between type 1 and type 2 papillary renal cell carcinoma (PRCC). Papillary renal cell carcinoma (PRCC), the second most common renal cell carcinoma (RCC) following clear cell RCC, accounts for 6 to 18% of all RCC cases [1]. It is a markedly heterogeneous entity characterized by different histologic subtypes, disease progression and clinical outcomes [2, 3]. Due to the overlaps in morphologic, immunohistochemical and molecular features, it is difficult to classify all PRCCs into subtypes absolutely with current controversial criteria [2, 6, 8]
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