P1-121 - Prognostic Factors of Renal Collecting Duct Carcinoma based on Clinical Features and Effective Chemotherapy

Abstract

ABSTRACT Background Collecting duct carcinoma (CDC) of the kidney is an aggressive disease with a poor prognosis and accounts for less than 1% of all renal cancers. To date, there is still no established standard therapy for CDC. The aim of this study is an investigation of clinicopathologic findings of CDC and the correlation of disease status with a prognosis. Methods From 1996 to 2009, 35 patients with CDC were treated at eight medical centers. The diagnosis of CDC was made based on nephrectomy in 27 cases and renal biopsy in 8 cases. We report on tumor characteristics, patient treatments and outcomes. Results The median age was 56 years (range, 29–82 years). Twenty seven of the 35 patients underwent nephrectomy for initial treatment, 4 patients received chemotherapy, and 4 patients did not receive any treatment. The median follow-up was 15.8 months (range, 0.6–88.4 months). Fourteen (40%) deaths were reported. The median progression free survival (PFS) and overall survival (OS) were 5.47 months (95% CI 3.97 to 6.96) and 54.37 months (95% CI 0.0 to 109.2), respectively. Of the 35 patients, 21 patients received chemotherapy (4 with Gemcitabine/platinum, 3 with Methotrexate, Vinblastine, Adriamycin, and Cisplatin), immunotherapy (10 with IFN ± IL-2), and targeted therapy (4 with Sunitinib). Median time to progression (TTP) for the treated patients was 2.9 months, with no statistically significant difference between the therapies (P=0.853). The median OS (overall survival) for patients for stage IV who had a palliative chemotherapy was 18.40 months (95% CI 0 to 41.94) and the median OS for those who did not was 4.53 months (95% CI 0 to 9.12). This showed that those who were treated had a significantly better OS rate (p=0.018). Conclusions CDC is a highly aggressive form of renal cell carcinoma. Most of all, accurate diagnosis is the most important for appropriate treatment. Although surgical treatment is the mainstay of the treatment, it is rarely possible to cure CDC completely with surgery alone. Thus, the study about the necessity and the role of adjuvant treatment after surgery is needed. So far, the treatment of these patients has been based on a number of chemotherapy regimens, including cisplatin–gemcitabine and immunotherapy because the distal nephron is the origin that makes this tumor more similar to urothelial carcinoma. The results of these experiences, however, have been somewhat disappointing. So, further studies might be needed to identify the role of targeted agents and to develop them based on biology.