Hong Baoan, Hou Huimin, Chen Lingxiao, Li Zhi, Zhang Zhipeng, Zhao Qiang, Du Xin, Li Yuan, Ye Xiongjun, Xu Wanhai, Liu Ming, Zhang Ning
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Urology, Peking University Cancer Hospital & Institute, Beijing, China.
Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Front Oncol. 2021 Sep 21;11:753690. doi: 10.3389/fonc.2021.753690. eCollection 2021.
The 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.
A 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.
Of 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 ( < 0.001) and WHO International Society of Urological Pathology (WHO/ISUP) grading ( < 0.001). Furthermore, tumor necrosis was more common in type 2 PRCC than type 1 PRCC ( = 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 ( = 0.0032 and = 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 ( = 0.004) and WHO/ISUP grading ( = 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 ( = 0.159 and = 0.239, respectively).
This 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.
本研究旨在比较1型和2型乳头状肾细胞癌（PRCC）的临床病理特征，并探讨中国人群中PRCC的预后因素。
回顾性纳入来自中国五个医学中心的242例PRCC患者。其中，82例为1型PRCC，160例为2型PRCC。对临床病理特征和肿瘤学结局进行回顾。采用Kaplan-Meier分析和对数秩检验来描述无进展生存期（PFS）和总生存期（OS）。使用单因素和多因素Cox比例风险回归模型分析PRCC的预后因素。
242例患者中，手术时的平均年龄为55.3±13.1岁。平均肿瘤大小为5.1±3.1 cm。与1型PRCC患者相比，2型PRCC患者的肿瘤更大，更有可能接受根治性肾切除术。此外，2型PRCC患者的肿瘤分期更高（<0.001），世界卫生组织/国际泌尿病理学会（WHO/ISUP）分级更高（<0.001）。此外，2型PRCC中肿瘤坏死比1型PRCC更常见（=0.030）。Kaplan-Meier生存分析显示，1型PRCC患者的PFS和OS明显优于2型PRCC患者（分别为=0.0032和=0.0385）。单因素分析显示，肿瘤大小、手术方式、pT分期、WHO/ISUP分级和微血管侵犯是2型PRCC患者PFS和OS的重要预测因素。多因素分析中，只有pT分期（=0.004）和WHO/ISUP分级（=0.010）是独立危险因素。在pT1期的2型PRCC患者中，部分肾切除术组和根治性肾切除术组的PFS和OS无显著差异（分别为=0.159和=0.239）。
这项多机构研究揭示了1型和2型PRCC在临床病理变量和肿瘤学结局方面的显著差异。对于pT1期的2型PRCC，部分肾切除术的预后不劣于根治性肾切除术，可以考虑保留肾单位手术。
