Nephron-Sparing Surgery for Adult Xp11.2 Translocation Renal Cell Carcinoma at Clinical T1 Stage: A Multicenter Study in China

Ning Liu,Linfeng Xu,Xiaozhi Zhao,Wei Xu,Hongqian Guo,Qiancheng Shi,Gutian Zhang,Lihua Zhang,Xiaogong Li,Feng Qu,Wenyuan Zhuang,Dongmei Li,Zhenhao Yang,Weidong Gan,Jing Sun,Ruipeng Jia,Wenliang Ma

doi:10.1245/s10434-020-08813-y

Abstract

PurposeTo evaluate the oncologic efficacy and feasibility of nephron-sparing surgery (NSS) in adult Xp11.2 translocation renal cell carcinoma (RCC).Patients and MethodsSeventy patients with Xp11.2 translocation RCC and 273 with conventional RCC from five institutions in Nanjing were retrospectively studied. All patients were older than 18 years and were categorized into clinical T1 (cT1) stage using preoperative imaging. Using the preoperative imaging and electronic medical records, anatomical and pathological features were collected and analyzed.ResultsAmong patients with Xp11.2 translocation RCC, 18/36 (50.0%) with cT1a and 12/34 (35.3%) with cT1b tumors underwent NSS. The respective proportions in the conventional RCC group were 121/145 (83.4%) and 93/128 (72.7%). Among cT1a tumors, the Xp11.2 translocation RCCs tended to be adjacent to the collecting system, sinus, and axial renal midline compared with conventional RCCs. Patients with Xp11.2 translocation RCCs who underwent NSS had comparable progression-free survival (PFS) and overall survival to radical nephrectomy (RN) patients (P > 0.05). Among cT1b tumors, surgical margin positivity and pelvicalyceal, vascular, and region lymphatic involvement were more likely to occur in the Xp11.2 translocation RCCs (P < 0.05). Patients with Xp11.2 translocation RCC who underwent RN had a more favorable PFS than those who underwent NSS (P = 0.048). However, multivariate analysis of PFS did not identify surgical method as a risk factor (P = 0.089).ConclusionsAmong adults with Xp11.2 translocation RCC, NSS can be an alternative for patients with cT1a tumor but should be performed with more deliberation in patients with cT1b tumors.

Highlights

Among cT1a tumors, the Xp11.2 translocation renal cell carcinoma (RCC) tended to be adjacent to the collecting system, sinus, and axial renal midline compared with conventional RCCs
Among cT1b tumors, surgical margin positivity and pelvicalyceal, vascular, and region lymphatic involvement were more likely to occur in the Xp11.2 translocation RCCs (P \ 0.05)
Among adults with Xp11.2 translocation RCC, nephron-sparing surgery (NSS) can be an alternative for patients with cT1a tumor but should be performed with more deliberation in patients with cT1b tumors

Summary

Results

Among patients with Xp11.2 translocation RCC, 18/36 (50.0%) with cT1a and 12/34 (35.3%) with cT1b tumors underwent NSS. Among cT1a tumors, the Xp11.2 translocation RCCs tended to be adjacent to the collecting system, sinus, and axial renal midline compared with conventional RCCs. Patients with Xp11.2 translocation RCCs who underwent NSS had comparable progressionfree survival (PFS) and overall survival to radical nephrectomy (RN) patients (P [ 0.05). The World Health Organization recognized Xp11.2 translocation RCC as a distinctive RCC entity in 20041 and reclassified it into microphthalmia transcription factor family translocation RCCs in 2016.2 Xp11.2 translocation RCC shows a more invasive course and more aggressive biological behavior than non-Xp11.2 translocation RCC,[3,4] Xp11 translocation RCC and clear cell RCC (ccRCC) have similar clinical courses.[5] Up to half of patients with Xp11.2 translocation RCC present with regional progress or metastasis.[6,7] Currently, complete excision is the most effective therapy for local Xp11.2 translocation RCC. Considering the aggressive biological behavior of Xp11.2 translocation RCC, we designed a multicenter study to investigate the feasibility of NSS for Xp11.2 translocation RCC based on the most comprehensive clinical data

Study Design and Patient Selection

RESULTS

DISCUSSION