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Impact of Renal Cell Carcinoma Histological Variants on Recurrence After Partial Nephrectomy: A Multi-Institutional, Prospective Study (UROCCR Study 82)

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The prognostic impact of renal cell carcinoma (RCC) morphotype remains unclear in patients who undergo partial nephrectomy (PN). Our objective was to determine the risk factors for recurrence after PN, including RCC morphotype.

Methods

Patients with RCC who had undergone PN were extracted from the prospective, national French database, UroCCR. Patients with genetic predisposition, bilateral or multiple tumours, and those who had undergone secondary totalization were excluded. Primary endpoint was 5-year, recurrence-free survival (RFS), and secondary endpoint was overall survival (OS). Risk factors for recurrence were assessed by multivariable Cox regression analysis.

Results

Overall, 2,767 patients were included (70% male; median age: 61 years [interquartile range (IQR) 51-69]). Most (71.5%) of the PN procedures were robot-assisted. Overall, 2,573 (93.0%) patients were recurrence free, and 74 died (2.7%). Five-year RFS was 84.9% (IQR 82.4-87.4). A significant difference in RFS was observed between RCC morphotypes (p < 0.001). Surgical margins (hazard ratio [HR] = 2.0 [95% confidence interval (CI): 1.3-3.2], p < 0.01), pT stage >1 (HR = 2.6 [95% CI: 1.8-3.7], p < 0.01]) and Fuhrmann grade >2 (HR = 1.9 [95% CI: 1.4-2.6], p < 0.001) were risk factors for recurrence, whereas chromophobe subtype was a protective factor (HR = 0.08 [95% CI: 0.01-0.6], p = 0.02). Five-year OS was 94.0% [92.4-95.7], and there were no significant differences between RCC subgroups (p = 0.06). The main study limitation was its design (multicentre national database), which may be responsible for declarative bias.

Conclusions

Chromophobe morphotype was significantly associated with better RFS in RCC patients who underwent PN. Conversely, pT stage, Fuhrman group and positive surgical margins were risk factors for recurrence.

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Funding

The authors declare no funding for this study.

Author information

Authors and Affiliations

  1. Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Hôpital Pitié-Salpêtrière, Urology, F-75013, Paris, France

    Thomas Tabourin MD, Ugo Pinar MD, Jerome Parra MD, Christophe Vaessen MD & Morgan Roupret MD, PhD

  2. Department of Urology, University Hospital of Rennes, Rennes, France

    Charles-Karim Bensalah MD, PhD

  3. Department of Urology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France

    Francois Audenet MD, PhD

  4. Department of Urology, University Hospital of Angers, Angers, France

    Pierre Bigot MD, PhD

  5. Department of Urology, APHP, Henri Mondor University Hospital, Créteil, France

    Cecile Champy MD

  6. Department of Urology, University Hospital of Lille, Lille, France

    Jonathan Olivier MD

  7. Department of Urology, University Hospital of Tours, Tours, France

    Franck Bruyere MD, PhD

  8. Department of Urology, University Hospital of Toulouse, Toulouse, France

    Nicolas Doumerc MD, PhD

  9. Department of Urology, University Hospital of Lyon, Lyon, France

    Philippe Paparel MD, PhD

  10. APHP Department of Urology, Bicetre University Hospital, Paris Saclay University, Le Kremlin Bicetre, France

    Bastien Parier MD

  11. Department of Urology, University Hospital of Rouen, Rouen, France

    Francois-Xavier Nouhaud MD

  12. Department of Urology, Hospital Saint Joseph, Paris, France

    Xavier Durand MD, PhD

  13. Department of Urology, University Hospital of Strasbourg, Strasbourg, France

    Herve Lang MD, PhD

  14. Department of Urology, Institut Paoli-Calmettes, Marseille, France

    Nicolas Branger MD

  15. Department of Urology, University Hospital of Grenoble, Grenoble, France

    Jean-Alexandre Long MD, PhD

  16. Department of Urology, University Hospital of Nice, Nice, France

    Matthieu Durand MD, PhD

  17. Department of Urology, University Hospital of Caen, Caen, France

    Thibaut Waeckel MD

  18. Department of Urology, University Hospital of Poitiers, Poitiers, France

    Thomas Charles MD

  19. Sorbonne Université, GRC n°5, AP-HP, Tenon Hospital, 75020, Paris, France

    Olivier Cussenot MD, PhD

  20. Urology Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France

    Evanguelos Xylinas MD, PhD

  21. Department of Urology, University Hospital of Marseille, Marseille, France

    Romain Boissier MD, PhD

  22. Department of Urology, University Hospital of Reims, Reims, France

    Ricky Tambwe MD

  23. Department of Urology, Hospital of Mont-de-Marsan, Mont-de-Marsan, France

    Jean-Jacques Patard MD, PhD

  24. Department of Urology, University Hospital of Bordeaux, Bordeaux, France

    Jean-Christophe Bernhard MD, PhD

Authors
  1. Thomas Tabourin MD
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  2. Ugo Pinar MD
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  18. Jean-Alexandre Long MD, PhD
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  27. Jean-Christophe Bernhard MD, PhD
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  28. Morgan Roupret MD, PhD
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Correspondence to Morgan Roupret MD, PhD.

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Tabourin, T., Pinar, U., Parra, J. et al. Impact of Renal Cell Carcinoma Histological Variants on Recurrence After Partial Nephrectomy: A Multi-Institutional, Prospective Study (UROCCR Study 82). Ann Surg Oncol 29, 7218–7228 (2022). https://doi.org/10.1245/s10434-022-12052-8

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