Abstract
ObjectiveThe purpose of this study was to compare the clinicopathological characteristics of type 1 and type 2 papillary renal cell carcinoma (PRCC) and to explore the prognostic factors of PRCC in the Chinese population.MethodsA total of 242 patients with PRCC from five Chinese medical centers were retrospectively included. From them, 82 were type 1 PRCC and 160 were type 2 PRCC. Clinicopathological features and oncologic outcomes were reviewed. The Kaplan–Meier analysis and log-rank test were performed to describe the progression-free survival (PFS) and overall survival (OS). Univariate and multivariate Cox proportional hazards regression models were used to analyze the prognostic factors of PRCC.ResultsOf the 242 patients, the average age at surgery was 55.3 ± 13.1 years. The mean tumor size was 5.1 ± 3.1 cm. Compared with type 1 PRCC patients, type 2 PRCC patients had a larger tumor size and were more likely to undergo radical nephrectomy. Besides, type 2 PRCC patients had higher tumor stage (p < 0.001) and WHO International Society of Urological Pathology (WHO/ISUP) grading (p < 0.001). Furthermore, tumor necrosis was more common in type 2 PRCC than type 1 PRCC (p = 0.030). The Kaplan–Meier survival analysis showed that the PFS and OS of type 1 PRCC patients were significantly better than those of type 2 PRCC patients (p = 0.0032 and p = 0.0385, respectively). Univariate analysis showed that tumor size, surgical procedures, pT stage, WHO/ISUP grading, and microvascular invasion were significant predictors of PFS and OS for type 2 PRCC patients. In the multivariate analysis, only pT stage (p = 0.004) and WHO/ISUP grading (p = 0.010) were the independent risk factors. Among type 2 PRCC patients with pT1 stage, no significant difference was found in PFS and OS between the partial nephrectomy and radical nephrectomy groups (p = 0.159 and p = 0.239, respectively).ConclusionThis multi-institutional study reveals the significant differences in clinicopathological variables and oncologic outcomes between type 1 and 2 PRCC. For type 2 PRCC in pT1 stage, the prognosis of partial nephrectomy is not inferior to that of radical nephrectomy, and nephron-sparing surgery can be considered.
Highlights
Papillary renal cell carcinoma (PRCC) is one of the most common renal cell carcinoma (RCC), second only to clear cell RCC, accounting for 15% to 20% of all RCCs [1]
Univariate analysis showed that tumor size (p = 0.015), surgical procedures (p = 0.010), pathologic T (pT) stage (p < 0.001), WHO/ISUP grading (p < 0.001), and microvascular invasion (p = 0.001) were significantly associated with progression-free survival (PFS) (Table 2)
We revealed that type 2 patients had a more advanced pT stage and higher WHO/ISUP grading (p < 0.001) than had type 1
Summary
Papillary renal cell carcinoma (PRCC) is one of the most common renal cell carcinoma (RCC), second only to clear cell RCC, accounting for 15% to 20% of all RCCs [1]. It has significant heterogeneity, mainly for the different histopathological subtypes, biological behaviors, and clinical outcomes. The initial study by Delahunt and Eble reported that PRCC can be categorized into type 1 and type 2 based on histomorphological and immunohistochemical characteristics [2]. The two PRCC subtypes have differences in clinicopathological characteristics and prognosis. There is still a lack of studies to reveal the different clinical significance between PRCC subtypes in the Chinese population
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