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Prognostic significance of Fuhrman grade and age for cancer-specific and overall survival in patients with papillary renal cell carcinoma: results of an international multi-institutional study on 2189 patients

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A Letter to the Editor to this article was published on 18 December 2017

Abstract

Purpose

Because the prognostic impact of the clinical and pathological features on cancer-specific survival (CSS) and overall survival (OS) in patients with papillary renal cell carcinoma (papRCC) is still controversial, we want to assess the impact of clinicopathological features, including Fuhrman grade and age, on survival in surgically treated papRCC patients in a large multi-institutional series.

Methods

We established a comprehensive multi-institutional database of surgically treated papRCC patients. Histopathological data collected from 2189 patients with papRCC after radical nephrectomy or nephron-sparing surgery were pooled from 18 centres in Europe and North America. OS and CSS probabilities were estimated using the Kaplan–Meier method. Multivariable competing risks analyses were used to assess the impact of Fuhrman grade (FG1-FG4) and age groups (<50 years, 50–75 years, >75 years) on cancer-specific mortality (CSM).

Results

CSS and OS rates for patients were 89 and 81% at 3 years, 86 and 75% at 5 years and 78 and 41% at 10 years after surgery, respectively. CSM differed significantly between FG 3 (hazard ratio [HR] 4.22, 95% confidence interval [CI] 2.17–8.22; p < 0.001) and FG 4 (HR 8.93, 95% CI 4.25–18.79; p < 0.001) in comparison to FG 1. CSM was significantly worse in patients aged >75 (HR 2.85, 95% CI 2.06–3.95; p < 0.001) compared to <50 years.

Conclusions

FG is a strong prognostic factor for CSS in papRCC patients. In addition, patients older than 75 have worse CSM than patients younger than 50 years. These findings should be considered for clinical decision making.

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Acknowledgements

The authors wish to thank all participants and collaborators of this study for their efforts in thoroughly documenting the data of patients with papillary renal cell carcinoma. We would also like to thank the following colleagues and acknowledge their support of this study: Markus Hohenfellner, Bernd Hoschke, and Raphaela Waidelich.

Author information

Author notes

  1. H. Borgmann and M. Musquera contributed equally as first authors.

Authors and Affiliations

  1. Department of Urology, University Hospital Mainz, Mainz, Germany

    H. Borgmann & A. Haferkamp

  2. Hospital Clínic, University of Barcelona, Barcelona, Spain

    M. Musquera & A. Vilaseca

  3. Department of Urology, Medical University of Vienna, Vienna, Austria

    T. Klatte & S. F. Shariat

  4. Department of Urology, Instituto Nacional de Cancerologia-INCan, Mexico City, Mexico

    A. Scavuzzo & M. A. Jimenez Rios

  5. Carl–Thiem–Klinikum Cottbus, Cottbus, Germany

    I. Wolff

  6. IRCCS San Raffaele Scientific Institute Department of Urology, Vita-Salute San Raffaele University, Milan, Italy

    U. Capitanio & P. Dell’Oglio

  7. Department of Urology, University of Muenster Medical Center, Münster, Germany

    L. M. Krabbe & E. Herrmann

  8. Department of Urology, HELIOS Hospital Bad Saarow, Bad Saarow, Germany

    T. Ecke

  9. Department of Urology and Paediatric Urology, Julius–Maximilians–University Medical Centre of Würzburg, Würzburg, Germany

    D. Vergho

  10. Mannheim Medical Center, Department of Urology, University of Heidelberg, Heidelberg, Germany

    N. Huck & N. Wagener

  11. Department of Urology, University Hospital Heidelberg, Heidelberg, Germany

    S. Pahernik

  12. Department of Urology, University Hospital Carl Gustav Carus, Dresden, Germany

    S. Zastrow & M. Wirth

  13. Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania

    C. Surcel & C. Mirvald

  14. Department of Urology, Faculty Hospital, Faculty of Medicine, Charles University in Pilsen, Pilsen, Czech Republic

    K. Prochazkova & M. Hora

  15. Department of Urology, Medical University Graz, Graz, Austria

    G. Hutterer & R. Zigeuner

  16. Department of Urology, ASL Abruzzo 2, Chieti, Italy

    L. Cindolo

  17. Department of Urology, Ludwig–Maximilians–University, Campus Grosshadern, Marchionistrasse 15, Munich, 81377, Germany

    C. G. Stief & S. D. Brookman-May

  18. Department of Urology, Klinikum St. Elisabeth Straubing, Straubing, Germany

    M. May

  19. Department of Urology, Universitat de Barcelona-Hospital Clínic, C/Villarroel, 170, 08036, Barcelona, Spain

    M. Musquera

Authors
  1. H. Borgmann
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  2. M. Musquera
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  3. A. Haferkamp
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  4. A. Vilaseca
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  5. T. Klatte
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  28. C. G. Stief
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  29. M. May
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  30. S. D. Brookman-May
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Contributions

HB data collection or management, data analysis, protocol/project development, manuscript writing/editing. MM protocol/project development, data collection or management, data analysis, Manuscript writing/editing. AH, AV, SFS, AS, MAJ-R, UC, PD, LMK, EH, TE, DV, NH, SP, SZ, MW, CS, CM, KP, GH, MH, CGS data collection or management, manuscript writing/editing. TK, IW, NW, RZ, LC data collection or management, data analysis, manuscript writing/editing. MM, SDB-M protocol/project development, data analysis, manuscript writing/editing.

Corresponding authors

Correspondence to M. Musquera or S. D. Brookman-May.

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This manuscript is not being simultaneously submitted elsewhere and no portion of the date has been or will be published elsewhere. The authors have no potential conflicts of interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Borgmann, H., Musquera, M., Haferkamp, A. et al. Prognostic significance of Fuhrman grade and age for cancer-specific and overall survival in patients with papillary renal cell carcinoma: results of an international multi-institutional study on 2189 patients. World J Urol 35, 1891–1897 (2017). https://doi.org/10.1007/s00345-017-2078-5

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