Impact of Histology and Tumor Grade on Clinical Outcomes Beyond 5 Years of Follow-Up in a Large Cohort of Renal Cell Carcinomas |
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| Affiliation: | 1. Department of Urology, IRCCS- Regina Elena National Cancer Institute, Rome, Italy;2. Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Italy;3. Division of Cancer Epidemiology Genetics, National Cancer Institute, NIH, Bethesda, MD;4. Department of Hematology and Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY;5. Department of Pathology, IRCCS- Regina Elena National Cancer Institute, Rome, Italy;6. Laboratory of Molecular Medicine and Biotechnology, University Campus Bio-Medico of Rome, Italy;7. Department of Clinical Sciences and Community Health, Università degli Studi di Milano and Fondazione IRCCS - Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy;8. Laboratory of Oncology, IRCCS H. “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG), Italy;9. Department of Urology, Sapienza University, Rome, Italy;1. Department of Medical Oncology, Istituto Oncologico della Svizzera Italiana (IOSI), Bellinzona, Switzerland;2. Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy;3. Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy;4. Department of Nuclear Medicine, PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy;5. Department of Pathology, IRCCS San Raffaele Hospital, Milan, Italy;6. Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy;7. Vita-Salute San Raffaele University, Milan, Italy;8. Foundation Medicine Inc., Cambridge, MA, United States;9. Upstate Medical University, Syracuse, NY, United States;1. Department of Radiation Oncology, Baylor College of Medicine, Houston, TX;2. Department of Radiation Oncology, University of Utah, Salt Lake City, UT |
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| Abstract: | IntroductionThe optimal length for clinical follow-up of renal cell carcinoma (RCC) patients is unclear. We evaluated the impact of ISUP/WHO tumor grade and histological subtype on short- and long-term survival and risk of recurrence/metastasis in a large cohort of RCC patients.Patients and MethodsWe studied 1679 RCC patients from a single referral center in Italy. Adjusted hazard ratios for overall survival were estimated using Cox regression models. Adjusted absolute risk of developing recurrence or metastasis was computed considering competing risks of mortality.ResultsDuring up to 13 years of follow-up, 175 (10.4%) RCC patients died, of whom 92% beyond 5 years. Hazard ratio of grade IV clear cell carcinomas (ccRCC) was 3.82 compared to grade II. Notably, 33% of recurrences and 56% of distant metastases occurred beyond 5 years of follow-up. The estimated probabilities of recurrence/metastasis were 15% and 45% within and beyond 5 years of follow-up, respectively. After 5 years, the absolute risk of recurrences increased also for papillary renal cell carcinoma type I (35.2%) and grade I ccRCC (17%).ConclusionAfter 5 years of follow-up, both risk of mortality and recurrences or metastases were high and were modified by histological types and tumor grade. These data strongly support histology- and grade-tailored surveillance strategies and long-term follow-up for RCC patients. |
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