Steffens Sandra, Roos Frederik C, Janssen Martin, Becker Frank, Steinestel Julie, Abbas Mahmoud, Steinestel Konrad, Wegener Gerd, Siemer Stefan, Thüroff Joachim W, Hofmann Rainer, Stöckle Michael, Schrader Mark, Hartmann Arndt, Junker Kerstin, Kuczyk Markus A, Schrader Andres J
Department of Urology and Urological Oncology, Hannover University Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
Virchows Arch. 2014 Oct;465(4):439-44. doi: 10.1007/s00428-014-1648-9. Epub 2014 Sep 2.
Chromophobe renal cell carcinoma (chRCC) is the third most common subtype of RCC, after clear cell (ccRCC) and papillary RCC. Its lower incidence and frequent exclusion from clinical trials might be why chRCC characteristics have not been extensively studied. The aim of our study was to examine tumor characteristics and long-term prognosis of chRCC compared to ccRCC. We collected 4,210 evaluable patients subjected to surgery for chRCC (n = 176) or ccRCC (n = 4,034) at five centers in Germany (University Hospitals of Hannover, Homburg/Saar, Mainz, Ulm, and Marburg) between 1990 and 2010. Patients with chRCC were significantly younger (mean, 60.1 vs. 62.1 years) and tended to be more frequently female (43.8 vs. 36.5 %). Although Fuhrman grade and median tumor diameter were not significantly different, significantly fewer patients with chRCC than with ccRCC presented with high tumor stage or metastasis at diagnosis (18.5 vs. 43.8 %). Moreover, significantly more chRCC patients were treated with partial nephrectomy (41.5 vs. 26.2 %). Accordingly, 5-year cancer-specific survival (CSS) rates were 83.2 % for chRCC against 75.8 % for ccRCC patients (p = 0.014, log rank). However, in multivariate analysis, chromophobe subtype was not confirmed as a significant positive prognostic factor for RCC (HR 0.88, 95 % CI 0.63-1.24; p = 0.48 Cox regression). This is one of the largest studies to date showing that chRCC is associated with a significantly lower risk of locally invasive tumor growth and metastatic disease than ccRCC. We conclude that the clinical behavior of chRCC is less aggressive than that of ccRCC, independent of Fuhrman grade or tumor size.
嫌色性肾细胞癌（chRCC）是肾细胞癌（RCC）的第三大常见亚型，仅次于透明细胞肾细胞癌（ccRCC）和乳头状肾细胞癌。其发病率较低且经常被排除在临床试验之外，这可能是chRCC的特征尚未得到广泛研究的原因。我们研究的目的是比较chRCC与ccRCC的肿瘤特征和长期预后。1990年至2010年间，我们在德国的五个中心（汉诺威大学医院、洪堡/萨尔大学医院、美因茨大学医院、乌尔姆大学医院和马尔堡大学医院）收集了4210例接受chRCC（n = 176）或ccRCC（n = 4034）手术的可评估患者。chRCC患者明显更年轻（平均年龄，60.1岁对62.1岁），且女性比例往往更高（43.8%对36.5%）。虽然富尔曼分级和肿瘤直径中位数无显著差异，但chRCC患者在诊断时出现高肿瘤分期或转移的比例明显低于ccRCC患者（18.5%对43.8%）。此外，接受部分肾切除术的chRCC患者明显更多（41.5%对26.2%）。相应地，chRCC患者的5年癌症特异性生存率（CSS）为83.2%，而ccRCC患者为75.8%（p = 0.014，对数秩检验）。然而，在多变量分析中，嫌色性亚型未被确认为RCC的显著阳性预后因素（风险比0.88，95%置信区间0.63 - 1.24；p = 0.48，Cox回归）。这是迄今为止最大的研究之一，表明chRCC与ccRCC相比，局部侵袭性肿瘤生长和转移性疾病的风险显著更低。我们得出结论，chRCC的临床行为比ccRCC的侵袭性更小，与富尔曼分级或肿瘤大小无关。
