Abstract
The goal of this study was to evaluate immunohistochemical and cytogenetic features and their prognostic value in papillary renal cell carcinoma (PRCC) subtypes. One hundred fifty-eight cases of PRCC were identified and reclassified by subtype. Tumoral expression of 29 molecular markers was determined by immunohistochemistry. Cytogenetic analyses were done on a prospective series of 65 patients. Associations with clinicopathologic information and disease-specific survival were assessed. Fifty-one patients (32%) had type 1 and 107 (68%) type 2 PRCC. Type 2 patients had worse Eastern Cooperative Oncology Group performance status, higher T stages, nodal and distant metastases, higher grades, and a higher frequency of necrosis, collecting system invasion and sarcomatoid features. Type 2 showed greater expression of vascular endothelial growth factor (VEGF)-R2 in the tumor epithelium, and of VEGF-R3 in both tumor epithelium and endothelium. Loss of chromosome 1p, loss of 3p, and gain of 5q were exclusively observed in type 2, whereas type 1 more frequently had trisomy 17. Type 2 PRCC was associated with worse survival than type 1, but type was not retained as an independent prognostic factor. Lower PTEN, lower EpCAM, lower gelsolin, higher CAIX, and higher VEGF-R2 and VEGF-R3 expression, loss of 1p, 3p, or 9p, and absence trisomy 17 were all associated with poorer prognosis. Type 2 PRCC is associated with more aggressive clinicopathologic features and worse outcome. Molecular and chromosomal alterations can distinguish between PRCC subtypes and influence their prognosis. The effect of 3p loss on survival in PRCC is opposite to the relationship seen in clear cell RCC.
Highlights
The goal of this study was to evaluate immunohistochemical and cytogenetic features and their prognostic value in papillary renal cell carcinoma (PRCC) subtypes
Type 2 was associated with worse Eastern Cooperative Oncology Group (ECOG) performance status, higher T stage, lymph node and distant
The main findings of this study are as follows: (a) type 1 and type 2 PRCC possess unique clinico pathologic and molecular profiles; (b) type 2 PRCC is associated with worse survival; metastatic type 1 has poorer survival than metastatic type 2 PRCC; (c) vascular endothelial growth factor (VEGF)-R2 and VEGF-R3 can assist in subdividing type 1 and type 2 PRCC because they are differently expressed; (d) PTEN, EpCAM, gelsolin, CAIX, and proteins of the VEGF family are associated with survival in PRCC; (e) trisomy 17 predicts improved survival, whereas loss of 1p, 3p, or 9p material lead to worse prognosis
Summary
The goal of this study was to evaluate immunohistochemical and cytogenetic features and their prognostic value in papillary renal cell carcinoma (PRCC) subtypes. The Heidelberg classification describes five subtypes, including clear cell, papillary, chromophobe, collecting duct, and unclassified RCC [1]. Several studies have suggested that patients with type 2 PRCC present with higher stage and nuclear grade (9 – 12), which leads to worse survival (12 – 14). The goals of this study were (a) to evaluate clinicopathologic features and their prognostic value in PRCC subtypes, (b) to define an immunohistochemical profile of type 1 from type 2 PRCC, (c) to analyze the relevance of protein expression in predicting prognosis, and (d) to describe cytogenetic aberrations and their effect on survival. The University of California at Los Angeles Kidney Cancer Program Database
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