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Predictive value of histologic pattern for early recurrence in patients with local advanced and metastatic renal cell carcinoma (RCC)
B85: Predictive value of histologic pattern for early recurrence in patients with local advanced and metastatic renal cell carcinoma (RCC) Vaivode I.1, Sperga M.2, Baltiņa D.1, Doniņa S.1, Ulase D.3, Gordins S.4, Jakubovskis M.4, Beketovs S.4, Lietuvietis V.4 1
Riga East University Hospital, Latvian Oncology Centre, Riga, Latvia, 2Riga East University Hospital, Pathology Centre, Riga, Latvia, 3Riga Stradins University, Student, Riga, Latvia, 4Riga East University Hospital, Clinic of Urology, Riga, Latvia
INTRODUCTION & OBJECTIVES: The objective of the study was to investigate the role of histology for prediction of early recurrence after nephrectomy in patients with local, regionally advanced and metastatic RCC MATERIAL & METHODS: Altogether 396 patients with RCC treated at the Riga East University Hospital, Clinic of Urology from 01.01.2009 to 31.12.2011 were enrolled in this retrospective study. 315 patients with histologically proven RCC were included for further analysis. Patient follow-up continued up to 31.01.2014. Based on the time from nefrectomy to recurrence patients were stratified into 2 groups. Defined outcome was recurrence or cancer specific death within 2 years. Patients with different stages of RCC were analysed separately or together in respect to the probable predictive factors. Statistical analysis was performed by SPSS V.21: Spearman correlation and logistic binary regression methods. RESULTS: The histologic pattern of analysed cases included clear cell carcinoma (n=275; 87.3%), papillary carcinoma (n=21; 6.7%), chromophobe carcinoma (n=14; 4.4%) and unclassified or rare renal carcinomas (n=5; 1.6%). Disease free survival less than 2 years was observed in 14 patients with stage I disease (7.6%), 3 patients with stage II disease (9.7%), 15 patients with stage III disease (27.3 %) and 26 patients with stage IV disease (59.1%). There was a statistically significant correlation between early relapse and M status (rs=0.393; p<0.01), N status (rs=0.402; p<0.01), invasion beyond capsule (rs=0.317; p<0.01), venous involvement (rs=0.247; p<0.01), adrenal extension (rs=0.201; p<0.01), tumor necrosis (rs=0.198; p<0.01), tumor size (rs=0.250; p<0.01), grade (rs=0.290; p<0.01), lymph-vascular invasion (rs=0.300; p<0.01), surgical margins (rs=0.216; p<0.01) and age (rs=0.189; p=0.01). However multiple logistic regression analysis showed a statistically relevant predictive value only for two variables: M status (OR=8.1; 95% CI=1.2-52.6; p=0.029) and N status (OR=7.3; 95% CI=2.2-24.6; p=0.001). When analysed separately: for stage III patients - age and adrenal involvement; for stage IV patients - grade, extra-capsular invasion, tumour size, necrosis, venous involvement, lymph-vascular invasion, resection margins, N, M status and age proved statistically significant correlation with outcome. No relevant correlations of any variable was observed in patients with stage I and II RCC. CONCLUSIONS: Predictive significance of the histologic pattern for RCC recurrence within 2 years depends on the stage of RCC. The type of tumor and its size maintain prognostic relevance in advanced disease. In our study no definite routine histologic predictors were found for early recurrence in patients with stage I and II RCC. Further studies in order to find new predictive markers in early disease patients are needed. Eur Urol Suppl 2014; 13(2): e1203
e1203
Riga East University Hospital, Latvian Oncology Centre, Riga, Latvia, 2Riga East University Hospital, Pathology Centre, Riga, Latvia, 3Riga Stradins University, Student, Riga, Latvia, 4Riga East University Hospital, Clinic of Urology, Riga, Latvia
INTRODUCTION & OBJECTIVES: The objective of the study was to investigate the role of histology for prediction of early recurrence after nephrectomy in patients with local, regionally advanced and metastatic RCC MATERIAL & METHODS: Altogether 396 patients with RCC treated at the Riga East University Hospital, Clinic of Urology from 01.01.2009 to 31.12.2011 were enrolled in this retrospective study. 315 patients with histologically proven RCC were included for further analysis. Patient follow-up continued up to 31.01.2014. Based on the time from nefrectomy to recurrence patients were stratified into 2 groups. Defined outcome was recurrence or cancer specific death within 2 years. Patients with different stages of RCC were analysed separately or together in respect to the probable predictive factors. Statistical analysis was performed by SPSS V.21: Spearman correlation and logistic binary regression methods. RESULTS: The histologic pattern of analysed cases included clear cell carcinoma (n=275; 87.3%), papillary carcinoma (n=21; 6.7%), chromophobe carcinoma (n=14; 4.4%) and unclassified or rare renal carcinomas (n=5; 1.6%). Disease free survival less than 2 years was observed in 14 patients with stage I disease (7.6%), 3 patients with stage II disease (9.7%), 15 patients with stage III disease (27.3 %) and 26 patients with stage IV disease (59.1%). There was a statistically significant correlation between early relapse and M status (rs=0.393; p<0.01), N status (rs=0.402; p<0.01), invasion beyond capsule (rs=0.317; p<0.01), venous involvement (rs=0.247; p<0.01), adrenal extension (rs=0.201; p<0.01), tumor necrosis (rs=0.198; p<0.01), tumor size (rs=0.250; p<0.01), grade (rs=0.290; p<0.01), lymph-vascular invasion (rs=0.300; p<0.01), surgical margins (rs=0.216; p<0.01) and age (rs=0.189; p=0.01). However multiple logistic regression analysis showed a statistically relevant predictive value only for two variables: M status (OR=8.1; 95% CI=1.2-52.6; p=0.029) and N status (OR=7.3; 95% CI=2.2-24.6; p=0.001). When analysed separately: for stage III patients - age and adrenal involvement; for stage IV patients - grade, extra-capsular invasion, tumour size, necrosis, venous involvement, lymph-vascular invasion, resection margins, N, M status and age proved statistically significant correlation with outcome. No relevant correlations of any variable was observed in patients with stage I and II RCC. CONCLUSIONS: Predictive significance of the histologic pattern for RCC recurrence within 2 years depends on the stage of RCC. The type of tumor and its size maintain prognostic relevance in advanced disease. In our study no definite routine histologic predictors were found for early recurrence in patients with stage I and II RCC. Further studies in order to find new predictive markers in early disease patients are needed. Eur Urol Suppl 2014; 13(2): e1203
e1203