Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada.
Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
World J Urol. 2021 Feb;39(2):461-472. doi: 10.1007/s00345-020-03187-y. Epub 2020 Apr 6.
To compare survival outcomes of metastatic patients harbouring either papillary (pRCC) or clear-cell (ccRCC) renal cell carcinoma in overall population and according to treatment modality.
Within the Surveillance, Epidemiology and End Results database (2006-2015), we identified 6800 patients (585 papillary and 6215 clear-cell) with metastatic RCC. Propensity-score (PS) matching, Kaplan-Meier plots and multivariable Cox-regression models (CRMs) were used.
Overall, 585 (8.6%) patients harboured pRCC. Rates of nodal metastases were higher in patients with pRCC (49.7 vs. 23.3%; p < 0.001). Median overall survival (OS) was 13 vs. 18 months for pRCC vs. ccRCC patients. After multivariable adjustments, no difference in OS was recorded. Furthermore, after propensity-score matching, virtually the same results were recorded. Median OS of pRCC vs. ccRCC was 8 vs. 4 months for no treatment (NT), 11 vs. 12 months for targeted therapy alone (TT), 17 vs. 35 months for cytoreductive nephrectomy alone (CN) and 18 vs. 25 months for combination of CN with TT.
Metastatic pRCC patients exhibit poor survival, regardless of treatment received. Moreover, pRCC patients are more likely to present nodal metastases, compared to ccRCC patients, as demonstrated by twofold higher rates of lymph node invasion at diagnosis. These observations indicate that papillary variant represents more prognostically unfavorable tumor histology, in the context of metastatic RCC.
本研究旨在比较总体人群及不同治疗方式下，伴发乳头状（pRCC）或透明细胞（ccRCC）肾细胞癌（RCC）的转移性患者的生存结局。
我们检索了 Surveillance, Epidemiology and End Results 数据库（2006-2015 年）中的 6800 例转移性 RCC 患者（585 例伴发 pRCC，6215 例伴发 ccRCC）。我们采用倾向评分（PS）匹配、Kaplan-Meier 生存曲线和多变量 Cox 回归模型（CRMs）进行分析。
总体而言，8.6%的患者伴发 pRCC。pRCC 患者的淋巴结转移率更高（49.7% vs. 23.3%；p<0.001）。pRCC 患者的中位总生存（OS）时间为 13 个月，ccRCC 患者的中位 OS 时间为 18 个月。多变量调整后，两组患者的 OS 无差异。此外，经过倾向评分匹配后，也得到了相似的结果。未治疗（NT）患者中，pRCC 患者的中位 OS 时间为 8 个月，ccRCC 患者的中位 OS 时间为 4 个月；单独接受靶向治疗（TT）患者中，pRCC 患者的中位 OS 时间为 11 个月，ccRCC 患者的中位 OS 时间为 12 个月；单独接受细胞减灭性肾切除术（CN）患者中，pRCC 患者的中位 OS 时间为 17 个月，ccRCC 患者的中位 OS 时间为 35 个月；CN 联合 TT 患者中，pRCC 患者的中位 OS 时间为 18 个月，ccRCC 患者的中位 OS 时间为 25 个月。
伴发转移性 pRCC 的患者的生存结局较差，且无论接受何种治疗均如此。此外，与 ccRCC 患者相比，pRCC 患者更易发生淋巴结转移，其诊断时淋巴结侵犯的发生率为 ccRCC 患者的两倍。这些观察结果表明，在转移性 RCC 中，pRCC 代表了预后更差的肿瘤组织学亚型。
