Kammerer-Jacquet Solène-Florence, Brunot Angelique, Bensalah Karim, Campillo-Gimenez Boris, Lefort Mathilde, Bayat Sahar, Ravaud Alain, Dupuis Frantz, Yacoub Mokrane, Verhoest Gregory, Peyronnet Benoit, Mathieu Romain, Lespagnol Alexandra, Mosser Jean, Edeline Julien, Laguerre Brigitte, Bernhard Jean-Christophe, Rioux-Leclercq Nathalie
Service d'Anatomie et Cytologie Pathologiques, Université de Rennes 1, Université Bretagne Loire, Rennes, France; UMR 6290, IGDR, Rennes, France.
Service d'Oncologie Médicale, Centre Eugène Marquis, Rennes, France.
Urol Oncol. 2017 Oct;35(10):603.e7-603.e14. doi: 10.1016/j.urolonc.2017.05.015. Epub 2017 Jun 12.
The selection of patients with metastatic clear cell renal cell carcinoma (ccRCC) who may benefit from targeted tyrosine kinase inhibitors has been a challenge, even more so now with the advent of new therapies. Hilar fat infiltration (HFI) is a validated prognostic factor in nonmetastatic ccRCC (TNM 2009 staging system) but has never been studied in metastatic patients. We aimed to assess its phenotype and prognostic effect in patients with metastatic ccRCC treated with first-line sunitinib.
In a multicentric study, we retrospectively included 90 patients and studied the corresponding ccRCC at the pathological, immunohistochemical, and molecular levels. Patient and tumor characteristics were compared using univariate and multivariate analysis. All the features were then studied by Cox models for prognostic effect.
HFI was found in 42 patients (46.7%), who had worse prognosis (Heng criteria) (P = 0.003), liver metastases (P = 0.036), and progressive diseases at first radiological evaluation (P = 0.024). The corresponding ccRCC was associated with poor pathological prognostic factors that are well known in nonmetastatic ccRCC. For these patients, median progression-free survival was 4 months vs. 13 months (P = 0.02), and median overall survival was 14 months vs. 29 months (P = 0.006). In a multivariate Cox model integrating all the variables, only poor prognosis, according to the Heng criteria and HFI, remained independently associated with both progression-free survival and overall survival.
HFI was demonstrated for the first time to be an independent poor prognostic factor. Its potential role in predicting resistance to antiangiogenic therapy warrants further investigation.
