Matthias May1, Cristian Surcel2, Umberto Capitanio3, Paolo Dell'Oglio3, Tobias Klatte4, Shahrokh Shariat4, Thorsten Ecke5, Ingmar Wolff6, Daniel Vergho7, Nina Wagener8, Nina Huck8, Sascha Pahernik9, Stefan Zastrow10, Manfred Wirth10, Hendrik Borgmann11, Axel Haferkamp11, Mireia Musquera12, Laura M Krabbe13, Edwin Herrmann13, Anna Scavuzzo14, Cristian Mirvald2, Georg Hutterer15, Richard Zigeuner15, Christian G Stief16, Raphaela Waidelich16, Luca Cindolo17, Krystina Kalusova18, Sabine D Brookman-May16. 1. a Department of Urology , Klinikum St. Elisabeth Straubing , Straubing , Germany. 2. b Centre of Urological Surgery, Dialysis and Renal Transplantation , Fundeni Clinical Institute , Bucharest , Romania. 3. c Department of Urology , Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute , Milan , Italy. 4. d Department of Urology , Medical University of Vienna , Vienna , Austria. 5. e Department of Urology , Hospital Bad Saarow , Bad Saarow , Germany. 6. f Department of Urology , Carl-Thiem-Klinikum Cottbus , Cottbus , Germany. 7. g Department of Urology and Paediatric Urology , Julius-Maximilians-University Medical Centre of Wuerzburg , Wuerzburg , Germany. 8. h Department of Urology , University Hospital Mannheim , Mannheim , Germany. 9. i Department of Urology , Klinikum Nürnberg , Nürnberg, Germany. 10. j Department of Urology , Carl Gustav Carus University Dresden, University Hospital , Germany. 11. k Department of Urology , University Hospital Mainz , Mainz , Germany. 12. l Department of Nephrology and Urology , University of Barcelona , Barcelona , Spain. 13. m Department of Urology , University of Muenster Medical Center , Muenster , Germany. 14. n Department of Urology , Instituto Nacional de Cancerologia-INCan , Mexico City , Mexico. 15. o Department of Urology , Medical University Graz , Graz , Austria. 16. p Department of Urology , Ludwig-Maximilians University, Campus Grosshadern , Munich , Germany. 17. q Department of Urology , Pio Da Pietrelcina Hospital , Vasto , Italy. 18. r Department of Urology , Faculty of Medicine, Charles University , Pilsen , Czech Republic.
Abstract
OBJECTIVE: Studies on the prognostic reliability of the Union for International Cancer Control tumor, node, metastasis (TNM) staging system for renal cell carcinoma (RCC) predominantly focus on clear-cell RCC. Therefore, the aim of this study was to investigate whether the oncological prognosis of surgically treated papillary RCC (papRCC) patients is reliably given by the current TNM system, by analyzing the largest database reported to date. MATERIALS AND METHODS: Data on 2325 papRCC patients who underwent surgical treatment in 1984- 2015 were collated from 17 international centers (median follow-up 47 months). Tumor stage was adapted to the 7th edition of the TNM system. Multivariable, bootstrap-corrected Cox regression models were applied to assess the independent impact of the TNM system on cancer-specific mortality (CSM) and all-cause mortality (ACM). RESULTS: The median age at diagnosis was 63 years (interquartile range 54-70 years) and 77% of patients were male. Nephron-sparing surgery was performed in 42%, and 82% were with symptom free at diagnosis. In 6.7% (n = 156), organ metastasis (stage M1) was present at the time of surgery. On multivariable analysis, the TNM system and Fuhrman grade had an independent impact on both CSM and ACM, while patient age affected ACM only. The discriminative ability of the pT classification was significant for both endpoints: 5 year CSM rates were 5%, 17%, 36% and 56% for stages pT1, pT2, pT3 and pT4, respectively (each p < 0.001). The pT classification contributed significantly to the predictive accuracy of the CSM and ACM models by 6.3% and 2.5%, respectively (each p < 0.001). CONCLUSIONS: The 2010 TNM staging system can be reliably applied to papRCC patients and allows certain prognostic discrimination.
OBJECTIVE: Studies on the prognostic reliability of the Union for International Cancer Control tumor, node, metastasis (TNM) staging system for renal cell carcinoma (RCC) predominantly focus on clear-cell RCC. Therefore, the aim of this study was to investigate whether the oncological prognosis of surgically treated papillary RCC (papRCC) patients is reliably given by the current TNM system, by analyzing the largest database reported to date. MATERIALS AND METHODS: Data on 2325 papRCC patients who underwent surgical treatment in 1984- 2015 were collated from 17 international centers (median follow-up 47 months). Tumor stage was adapted to the 7th edition of the TNM system. Multivariable, bootstrap-corrected Cox regression models were applied to assess the independent impact of the TNM system on cancer-specific mortality (CSM) and all-cause mortality (ACM). RESULTS: The median age at diagnosis was 63 years (interquartile range 54-70 years) and 77% of patients were male. Nephron-sparing surgery was performed in 42%, and 82% were with symptom free at diagnosis. In 6.7% (n = 156), organ metastasis (stage M1) was present at the time of surgery. On multivariable analysis, the TNM system and Fuhrman grade had an independent impact on both CSM and ACM, while patient age affected ACM only. The discriminative ability of the pT classification was significant for both endpoints: 5 year CSM rates were 5%, 17%, 36% and 56% for stages pT1, pT2, pT3 and pT4, respectively (each p < 0.001). The pT classification contributed significantly to the predictive accuracy of the CSM and ACM models by 6.3% and 2.5%, respectively (each p < 0.001). CONCLUSIONS: The 2010 TNM staging system can be reliably applied to papRCC patients and allows certain prognostic discrimination.