Keiichi Ito1, Shuji Mikami2, Katsunori Tatsugami3, Naoya Masumori4, Nobuo Shinohara5, Tsunenori Kondo6, Shotaro Nakanishi7, Yoji Nagashima8, Masatoshi Eto9, Tomomi Kamba10, Naoto Kuroda11, Yoshihiko Tomita12, Hideyasu Matsuyama13, Tetsuro Onishi14, Tomoyasu Tsushima15, Hayakazu Nakazawa16, Mototsugu Oya17, Seiichiro Ozono18, Seiji Naito19, Tomohiko Asano20. 1. Department of Urology, National Defense Medical College, Saitama, Japan. Electronic address: itok@ndmc.ac.jp. 2. Department of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan. 3. Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 4. Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan. 5. Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 6. Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. 7. Department of Urology, University of the Ryukyus Graduate School of Medicine, Okinawa, Japan. 8. Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan. 9. Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Urology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan. 10. Department of Urology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan; Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 11. Department of Diagnostic Pathology, Kochi Red Cross Hospital, Kochi, Japan. 12. Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan; Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan. 13. Department of Urology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan. 14. Department of Urology, Seirei Citizen Hospital, Chiba, Japan. 15. Division of Urology, NHO Okayama Medical Center, Okayama, Japan. 16. Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan. 17. Department of Urology, Keio University School of Medicine, Tokyo, Japan. 18. Department of Urology, Hamamatsu University School of Medicine, Shizuoka, Japan. 19. Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Urology, Harasanshin Hospital, Fukuoka, Japan. 20. Department of Urology, National Defense Medical College, Saitama, Japan.
Abstract
BACKGROUND: Standard treatments have not been established in metastatic papillary renal-cell carcinoma (PRCC). We aimed to investigate treatment outcomes in patients with mPRCC. PATIENTS AND METHODS: This study included 51 patients who were diagnosed with PRCC at 14 institutions. Pathologic slides were reviewed by pathologists. The associations between clinical factors and overall survival (OS) were analyzed. RESULTS: Final pathologic diagnoses could be determined in 50 patients. Thirty-five tumors were diagnosed as PRCC (type 2 PRCC, 91.4%), and 15 were diagnosed as other histologic types. Targeted therapies (TTs) were provided to 25 mPRCC patients. Patients treated with TT survived significantly longer than those treated before the era of TT (median OS, 22.5 vs. 6.3 months; P = .0035). Median OS of patients who experienced stable disease for ≥ 9 months using single TT was 43.1 months. Patients treated with a tyrosine kinase inhibitor (TKI) as first-line TT survived longer after TT initiation than those treated with an mTOR inhibitor (median, 22.4 vs. 11.7 months; P = .2684). Patients treated with TKIs in both first- and second-line settings had significantly better survival after TT initiation than those treated with a TKI in one therapy line and an mTOR inhibitor in the other (31.4 vs. 12.9 months, P = .0172). Patients treated with a TKI as second-line TT survived significantly longer after second-line TT initiation than did those treated with an mTOR inhibitor (16.2 vs. 7.4 months, P = .0016). CONCLUSION: Prognoses of patients with mPRCC were improved by TT, and TKIs appeared to be the treatment of choice in both the first- and second-line settings.
BACKGROUND: Standard treatments have not been established in metastatic papillary renal-cell carcinoma (PRCC). We aimed to investigate treatment outcomes in patients with mPRCC. PATIENTS AND METHODS: This study included 51 patients who were diagnosed with PRCC at 14 institutions. Pathologic slides were reviewed by pathologists. The associations between clinical factors and overall survival (OS) were analyzed. RESULTS: Final pathologic diagnoses could be determined in 50 patients. Thirty-five tumors were diagnosed as PRCC (type 2 PRCC, 91.4%), and 15 were diagnosed as other histologic types. Targeted therapies (TTs) were provided to 25 mPRCC patients. Patients treated with TT survived significantly longer than those treated before the era of TT (median OS, 22.5 vs. 6.3 months; P = .0035). Median OS of patients who experienced stable disease for ≥ 9 months using single TT was 43.1 months. Patients treated with a tyrosine kinase inhibitor (TKI) as first-line TT survived longer after TT initiation than those treated with an mTOR inhibitor (median, 22.4 vs. 11.7 months; P = .2684). Patients treated with TKIs in both first- and second-line settings had significantly better survival after TT initiation than those treated with a TKI in one therapy line and an mTOR inhibitor in the other (31.4 vs. 12.9 months, P = .0172). Patients treated with a TKI as second-line TT survived significantly longer after second-line TT initiation than did those treated with an mTOR inhibitor (16.2 vs. 7.4 months, P = .0016). CONCLUSION: Prognoses of patients with mPRCC were improved by TT, and TKIs appeared to be the treatment of choice in both the first- and second-line settings.