Real-World Outcome of 173 Metastatic Non-Clear Cell Renal Cell Carcinoma (nccRCC) Cases: The Experience of the Center Group for Genitourinary Tumors (original) (raw)
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medRxiv, 2020
Introduction A lot of research is available about clear cell renal carcinomas (ccRCC). But there are lesser known facts about other subtypes of renal malignancies. With advances in immunohistochemical and cytogenetic techniques, new variants of renal tumors are being increasingly reported. The treatment and prognosis of such rare malignancies is still an enigma. We performed this study to analyze the incidence, clinico- pathological features, surgical treatment, and survival of non-clear cell RCC at our institution. Materials and Methods: The histopathological reports of 77 Nephrectomy specimens who underwent surgical treatment for suspected renal tumors from 2013-2018 were retrospectively reviewed. 19 (24%) of patients had documented uncommon histologic variants of RCC. The clinical, demographic, and histologic characteristics of these patients were analyzed, and survival was evaluated. The characteristic light microscopy and immunohistochemical features of these lesions were docum...
Cancer Chemotherapy and Pharmacology, 2014
For almost the last two decades, interleukin-2 and interferon-have been the only systemic treatment options available for metastatic renal cell carcinoma. However, in recent years, Wve new targeted therapies namely sunitinib, sorafenib, temsirolimus, everolimus and bevacizumab have demonstrated clinical activity in these patients. With the availability of new targeted agents that are active in this disease, there is a need to continuously update the treatment algorithm of the disease. Due to the important advances obtained, the Spanish Oncology Genitourinary Group (SOGUG) has considered it would be useful to review the current status of the disease, including the genetic and molecular biology factors involved, the current predicting models for development of metastases as well as the role of surgery, radiotherapy and systemic therapies in the early-or late management of the disease. Based on this previous work, a treatment algorithm was developed.
Annals of Diagnostic Pathology, 2009
On the basis of the National Cancer Data Base (NCDB), we describe the disease characteristics and use of conventional prognostic parameters in a hospital-based cohort of pathologically confirmed renal cell carcinomas (RCCs). Between 1993 and 1998, the NCDB obtained 149 424 cases of kidney (and renal pelvis) cancers from registries all over the United States. This database was queried for 47 909 histologically specified RCCs. Survival outcome was analyzed based on conventional clinical and pathologic parameters reported to the database (up to 2003). Renal cell carcinoma was more common in men (male-female ratio = 1.6:1). The mean age was 62.6 years. Most (66.6%) were organ-confined (stage I/II) at the time of diagnosis. The mean tumor size was 6.49 cm. The 5-year observed survival of RCC was 62.9% for male and 68.1% for female and was 81.0% for younger than 40 years old and 64.2% for older than 40 years old. The 5-year observed survival of RCC patients by the fifth edition 1997 American Joint Committee on Cancer TNM staging were stages I, 77.8%; II, 72.8%; III, 55.0%; and IV, 16.9%, demonstrating a dramatic decline in patient survival at stage IV. By reported pathologic grade, significant stratification was achieved in the observed survival for RCC overall irrespective of histologic subtypes (grade 1, 77.8%; 2, 69.6%; 3, 48.8%; and 4, 35.3% 5-year observed survival). These large NCDB data in RCC confirm the importance of pathologic evaluation of traditional prognostic parameters of stage and grade in RCC and is a powerful resource in defining cancer patient characteristics and analysis of prognostic variables that helps influence future cancer care planning and resource allocation.
Systemic Therapy for Non–clear Cell Renal Cell Carcinomas: A Systematic Review and Meta-analysis
European Urology, 2014
E U R O P E A N U R O L O G Y 6 7 ( 2 0 1 5 ) 7 4 0 -7 4 9 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Context: Clinical data supporting the use of targeted agents for the treatment of metastatic renal cell carcinoma (RCC) are based predominantly on patients with clear cell histology. Little is known about the efficacy of these drugs in non-clear cell variants. Objective: To evaluate the efficacy of different clear cell RCC (ccRCC)-approved targeted agents among patients with non-ccRCC compared with ccRCC. Evidence acquisition: We conducted a systematic review of electronic databases to identify publications evaluating the outcomes of patients with non-ccRCC treated with targeted agents approved for treatment of ccRCC. Patients with sarcomatoid variant RCC were excluded from the main analysis but were evaluated as an independent cohort. End points of interest were response rate, median progression-free survival (PFS), and median overall survival (OS). Where possible, data were pooled in a meta-analysis. For studies of unselected patients with RCC, the outcomes of patients with non-ccRCC histology were compared with ccRCC. In exploratory analyses, outcomes of non-ccRCC with nonapproved agents were assessed. Evidence synthesis: A total of 49 studies comprising 7771 patients were included in the analysis. Of these, 1244 patients (16.0%) had non-ccRCC, 6300 (83.1%) had ccRCC, and 227 (2.9%) had sarcomatoid tumours. The overall response rate for non-ccRCC with targeted agents was 10.5%. In studies directly comparing non-ccRCC and ccRCC, there were significantly lower response rates for non-ccRCC (odds ratio for response: 0.52; 95% confidence interval, 0.40-0.68; p < 0.001). For non-ccRCC treated with targeted agents, median PFS and OS were 7.4 and 13.4 mo, respectively; for patients with ccRCC, these were 10.5 mo and 15.7 mo, respectively ( p value for difference <0.001 for both parameters). Conclusions: Patients with non-clear cell renal cell carcinoma (non-ccRCC) have significantly lower response rates and poorer median progression-free survival and overall survival than those with ccRCC. The optimal treatment of patients with non-ccRCC remains unclear and warrants further study. Patient summary: Systemic treatments for patients with renal cell carcinoma (RCC) tend to be significantly less effective for non-clear cell RCC, with lower response rates and worse progression-free survival and overall survival when compared with clear cell RCC. Optimal therapy remains unclear and warrants further study.
Characteristics and Treatment Challenges of Non-Clear Cell Renal Cell Carcinoma
Cancers, 2021
Simple Summary Non-clear cell renal cell carcinomas (ncRCC) make up a heterogeneous group subclassified into different subtypes that differ in genetic and biochemical characteristics from each other and from ccRCC. ncRCC are a rare finding in clinical practice, and no standard-of-care has yet been established. Treatment choices are in fact based on extrapolating results from clear cell RCC trials, retrospective data, or case reports. The aim of this review is to supplyt precise recommendations for each histological type focusing on pathogenetic mechanisms of nc-RCC, summarizing the therapeutic strategies adopted over the last few decades, and exploring the emerging role of immunotherapy and new targeted drugs as future potential treatment options. Abstract Non-clear cell renal cell carcinomas (RCC) comprise several rare and poorly described diseases, often characterized by bad prognosis and with no standard treatments available. The gap in their clinical management is linked to the ...
International journal of urology : official journal of the Japanese Urological Association, 2015
To describe the clinicopathological features and oncological outcomes of renal cell carcinoma diagnosed in Japan in 2007, the results of the large-scale renal cell carcinoma registration study carried out by the Japanese Urological Association are reported. The renal cell carcinoma survey was carried out by the Japanese Urological Association in 2012 to register newly diagnosed renal cell carcinoma cases in 2007 from 340 institutions nationwide. The survey included clinicopathological details, such as sex, age, family history, past history, smoking history, body mass index, reason for diagnosis, TNM classification, stage, histopathology, treatment and clinical outcomes. A total of 3663 cases diagnosed in 2007 were registered in this renal cell carcinoma registry program from 340 institutions. A total of 15 patients with a final diagnosis of oncocytoma were excluded, and 3648 cases of renal cell carcinoma were analyzed to evaluate oncological outcomes. The patients' median age wa...
Changing prognosis of renal cell carcinoma: a single-centre experience over 25 years
Journal of Clinical Urology, 2013
The objective of this research is to examine renal cancer nephrectomies over 25 years in our centre and the factors underlying changes in disease-specific survival. Patients and methods: Retrospective data analysis was performed on all patients undergoing nephrectomies at our institution for renal cell carcinoma (RCC) from 1983 to 2007. Data extracted from the Cancer Research Uro-Oncology Database (CRUD©) provided survival, clinical and prognostic information including tumour diameter, Fuhrman grade, WHO staging and age. Results: Analysis of 664 RCCs demonstrated a clear change in kidney cancer-specific survival over the past 25 years, with five-year survival improving from 42% (1983-1986) to 73% (1999-2002). The number of RCC nephrectomies has increased 10 fold. There was no significant change in operative mortality, age, grade, stage or mean tumour size. However, there was a five-fold increase in tumours <6 cm, corresponding to an equal-fold decrease in tumours 6-8 cm, but no change in tumours >8 cm. Tumour size >8 cm was a significant adverse prognostic marker. Conclusions: A 30% improvement in RCC cancer-specific survival has been seen in our centre over the last 25 years. This change relates to a shift to smaller tumours, lower histological grades and a higher volume of cases.