Abstract
BackgroundNon-clear cell renal cell carcinoma (ccRCC) includes histologically and molecularly distinct subtypes such as papillary, chromophobe, collecting duct, and sarcomatoid RCC, with an incidence ranging from 20% to 25%. Oncologic outcomes and the role of adjuvant systemic therapy [vascular endothelial growth factor inhibitor (VEGFi) or immunotherapy] for non-ccRCC are not well-described.ObjectiveTo assess the incidence and survival outcomes of non-ccRCC subtypes in comparison to ccRCC.MethodsThe National Cancer Database was utilized to identify patients with non-metastatic RCC (T1–T4, N0–N1) between 2004 and 2015. The non-ccRCC cohort was further stratified by histologic subtype: papillary, chromophobe, sarcomatoid, and collecting duct RCC. Multivariable Cox regression models were used to compare overall survival (OS).ResultsThe 5-year OS for chromophobe, papillary, clear cell, collecting duct, and sarcomatoid RCC was 91%, 82%, 81%, 44%, and 40%, respectively. After adjusting for clinicopathologic and treatment characteristics, there was no significant difference in OS between papillary RCC and ccRCC (p = 0.17). Patients with collecting duct and sarcomatoid subtypes were at over two times increased risk of death compared to patients with clear cell (p < 0.01 and p < 0.01, respectively). Conversely, patients with chromophobe RCC were at 36% decreased risk of death compared to ccRCC (p < 0.01).ConclusionsThis hospital-based analysis confirms that collecting duct and sarcomatoid histologic subtypes are uncommon and associated with poor survival after surgery when compared to the other RCC subtypes. Further studies are needed to evaluate the role of neoadjuvant and adjuvant systemic therapies in these subtypes to improve oncologic outcomes.
Highlights
While the majority of renal cell carcinomas (RCCs) are clear cell RCC, non-ccRCCs comprise up to 25% of RCCs
We identified patients with non-metastatic RCC (T1–T4, N0– N1) with histology including papillary, chromophobe, sarcomatoid, collecting duct, and ccRCC from 2004 to 2015 with age ≥18 years
220,170 RCC patients were included in our analysis
Summary
While the majority of renal cell carcinomas (RCCs) are clear cell RCC (ccRCC), non-ccRCCs comprise up to 25% of RCCs. NonccRCCs are further divided into histologic subtypes, including papillary (10%), chromophobe (5%), collecting duct (1%), and translocation RCC (
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