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Effect of pathological high-risk features on cancer-specific mortality in non-metastatic clear cell renal cell carcinoma: a tool for optimizing patient selection for adjuvant therapy

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Abstract

Purpose

Adjuvant therapies for non-metastatic renal cell carcinoma (nmRCC) are being tested to improve outcomes in patients with high-risk (hR) nmRCC. The objective of the current study is to test the ability of three hR features to identify patients who are at the highest risk of cancer-specific mortality (CSM) after partial or radical nephrectomy.

Methods

Within the Surveillance Epidemiology and End Results (SEER) database (1988–2013), we identified 23,632 nm “clear cell” RCC partial or radical nephrectomy patients with hR features: Fuhrman grade (FG) 3 or 4 or pathological classifications T3a or T3b or lymph node invasion (LNI), or combination of these. Kaplan–Meier analyses (KM) and multivariable Cox’s regression models (CRM) evaluated the effect of hR features on CSM.

Results

Overall 11,568 (48.9%) patients harbored FG3-4, 5575 (23.6%) pT3a/b, 140 (0.6%) LNI, 5366 (22.7%) FG3-4 and pT3a/b, 183 (0.8%) LNI and pT3a/b, 203 (0.9%) LNI and FG3-4 and 597 (2.5%) LNI, FG3-4 and pT3a/b. Median CSM-free survival was 51, 58 and 22 months for LNI and pT3a/b, for LNI and FG3-4 and for LNI, FG3-4 and pT3a/b and was not reached for the other groups. These results remained unchanged in multivariable CRMs, where all hR features represented independent predictors.

Conclusions

Individuals with combination of LNI with FG3-4 or pT3a/b and patients with all three hR features are at highest risk of CSM. In consequence, these patients may represent ideal candidates for adjuvant therapy either in clinical practice or future prospective trials.

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Acknowledgements

The authors have none to declare.

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Author notes

  1. Marco Bandini and Ariane Smith have contributed equally to this work.

Authors and Affiliations

  1. Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, MI, Italy

    Marco Bandini, Emanuele Zaffuto, Umberto Capitanio, Francesco Montorsi & Alberto Briganti

  2. Vita-Salute San Raffaele University, Milan, Italy

    Marco Bandini, Emanuele Zaffuto, Umberto Capitanio, Francesco Montorsi & Alberto Briganti

  3. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada

    Marco Bandini, Ariane Smith, Emanuele Zaffuto, Raisa S. Pompe, Michele Marchioni & Pierre I. Karakiewicz

  4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Raisa S. Pompe & Felix K. Chun

  5. Department of Urology, SS Annunziata Hospital, “G.D’Annunzio” University of Chieti, Chieti, Italy

    Michele Marchioni

  6. Division of Urology, McMaster University, Hamilton, ON, Canada

    Anil B. Kapoor

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

    Shahrokh F. Shariat

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  1. Marco Bandini
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  2. Ariane Smith
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Contributions

MB: Protocol/project development, Data collection or management, Data analysis, Manuscript writing/editing. AS, MM, UC: Manuscript writing/editing. EZ, FKC: Data analysis. RP: Data collection or management. AK, SFS: Data collection or management. FM, AB: Protocol/project development. PIK: Manuscript writing/editing, Protocol/project development.

Corresponding author

Correspondence to Marco Bandini.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. None conflict of interest.

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Bandini, M., Smith, A., Zaffuto, E. et al. Effect of pathological high-risk features on cancer-specific mortality in non-metastatic clear cell renal cell carcinoma: a tool for optimizing patient selection for adjuvant therapy. World J Urol 36, 51–57 (2018). https://doi.org/10.1007/s00345-017-2093-6

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  • DOI: https://doi.org/10.1007/s00345-017-2093-6

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