Survival rates at 5 years following partial or radical nephrectomy for renal cell carcinoma (RCC) vary depending on whether patients have favorable or unfavorable histologic subtypes, according to data presented at the AUA2021 Virtual Experience.
“These results have implications for developing personalized therapies that target high-risk, aggressive tumors that are otherwise reasonable to manage,” Adan Becerra, PhD, of Rush University in Chicago, Illinois, and colleagues concluded in a poster presentation.
Using the National Cancer Database, the investigators identified 282,623 patients who underwent partial or radical nephrectomy from 2004 to 2017. Of these, 839 patients had unfavorable histologies (medullary cell, collecting duct, and unspecified RCC). Favorable histologies included papillary, chromophobe, cystic, and clear cell subtypes. The study population had a median follow-up duration of 4.6 years.
The 5-year survival rates were significantly higher for patients with favorable rather than unfavorable histology (75% vs 39%), Dr Becerra’s group reported in a poster presentation.
In a propensity score matching analysis that adjusted for confounding by patient, treatment, tumor, and hospital factors, unfavorable histologies overall were significantly associated with a 75% increased risk for dying within 5 years compared with favorable histologies. Medullary cell, collecting duct, and unspecified RCC were significantly associated with 82%, 65%, and 71% increased risks of dying within 5 years, respectively.
The increased risks for 5-year mortality associated with unfavorable subtypes were independent of tumor characteristics, “suggesting that unfavorable histologies are mechanistically different than favorable histologies,” according to the investigators.
The latest findings add to mounting evidence of different treatment outcomes associated with various histologic subtypes of RCC. In a study of patients with intermediate-high-risk and high-risk RCC published online September 4, 2021 in Urology, Joshua Ikuemonisan, MD, of the University of Minnesota in Minneapolis, and colleagues found that patients with chromophobe RCC had significantly better overall and cancer-specific survival following nephrectomy relative to those with clear cell RCC, whereas those with the sarcomatoid subtype had significantly worse overall and cancer-specific survival.
Compared with patients who had clear cell RCC, those with chromophobe RCC had a 42% decreased risk for death from any cause and a 53% decreased risk for death from kidney cancer, Dr Ikuemonisan’s team reported. Overall and cancer-specific survival did not differ significantly between patients with papillary RCC and those with clear cell RCC.
In a study of 3331 patients who underwent partial or radical nephrectomy for RCC, Yasmin Abu-Ghanem, MD, of The Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel, and colleagues found that patients with clear cell RCC had a 5-year recurrence-free survival rate of 78% compared with 86% and 91% for those with papillary and chromophobe RCC, respectively, according to study findings published in European Urology Oncology.
Becerra A, Buac N, Greydanus Me, et al. Five year survival outcome comparison amongst patients with unfavorable vs. favorable renal cell carcinoma subtypes. Presented at: AUA2021 Virtual Experience held September 10-13. Abstract MP61-19.
Ikuemonisan J, Togun A, Oyejinmi I, Bakare A, Adejoro O. Influence of histologic subtypes and subtypes on survival outcomes of intermediate-high and high-risk renal cell carcinoma following nephrectomy: Findings from the SEER database. Urology. Published online September 4, 2021. doi:10.1016/j.urology.2021.08.034
Abu-Ghanem Y, Powles T, Capitanio U, et al. The impact of histologic subtype on the incidence, timing, and patterns of recurrence in patients with renal cell carcinoma after surgery-Results from RECUR Consortium. Eur Urol Oncol. 2021;4(3):473-482. doi:10.1016/j.euo.2020.09.005