Papillary renal cell carcinoma (RCC) type II subtype appears to be more unfavorable and aggressive than type I and leads to worse pathologic outcomes, according to investigators.
Among 447 patients treated with partial or radical nephrectomy for papillary RCC, 243 (54.4%) had type I and 204 (45.6%) had type II disease at pathology. Of the cohort, 27% of patients were symptomatic and 5% harbored metastatic disease at diagnosis.
Compared with papillary RCC type 1, type II tumors were significantly more likely to be stage T3 or higher (27% vs 11.5%), node positive (13.3% vs 4.5%), and grade 3 or higher (50% vs 9.4%) with tumor necrosis (61.8% vs 30%) or lymphovascular invasion (16.2% vs 3.7%), Giuseppe Rosiello, MD, of Urological Research Institute, IRCCS San Raffaele Scientific Institute in Milan, Italy, and colleagues reported in Urologic Oncology. After a median follow-up of 51 months, 2.5% and 11% of patients with papillary RCC type 2 had local relapse and cancer progression, respectively.
At 5 years, progression-free survival (83% vs 93%) and cancer-specific survival (89% vs 96%) was significantly lower for nonmetastatic pRCC type II vs type 1. On multivariable analysis, papillary RCC type II was significantly associated with a 3.0-fold higher risk of cancer progression and a 2.6-fold higher risk for cancer-specific mortality compared with papillary RCC type I.
According to Dr Rosiello’s team, their study findings “support the need for differentiating the clinical management and follow-up of patients with pRCC type II compared to type I pRCC after surgical treatment, due to different pathological features and consequently potential worse oncologic outcomes.” They recommended stricter clinical and radiological follow-up in patients with papillary RCC type II than advised by guidelines and, if confirmed by future studies, lymphadenectomy.
Basile G, Rosiello G, Larcher A, et al. Clinical, pathological and long-term oncologic outcomes of papillary type I vs. type II renal cell carcinoma. Urol Oncol. Published online May 31, 2022. doi:10.1016/j.urolonc.2022.05.012