Thomas Tabourin1, Ugo Pinar1, Jerome Parra1, Christophe Vaessen1, Charles-Karim Bensalah2, Francois Audenet3, Pierre Bigot4, Cecile Champy5, Jonathan Olivier6, Franck Bruyere7, Nicolas Doumerc8, Philippe Paparel9, Bastien Parier10, Francois-Xavier Nouhaud11, Xavier Durand12, Herve Lang13, Nicolas Branger14, Jean-Alexandre Long15, Matthieu Durand16, Thibaut Waeckel17, Thomas Charles18, Olivier Cussenot19, Evanguelos Xylinas20, Romain Boissier21, Ricky Tambwe22, Jean-Jacques Patard23, Jean-Christophe Bernhard24, Morgan Roupret25. 1. Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Hôpital Pitié-Salpêtrière, Urology, F-75013, Paris, France. 2. Department of Urology, University Hospital of Rennes, Rennes, France. 3. Department of Urology, Hôpital Européen Georges Pompidou, AP-HP Centre, Université de Paris, Paris, France. 4. Department of Urology, University Hospital of Angers, Angers, France. 5. Department of Urology, APHP, Henri Mondor University Hospital, Créteil, France. 6. Department of Urology, University Hospital of Lille, Lille, France. 7. Department of Urology, University Hospital of Tours, Tours, France. 8. Department of Urology, University Hospital of Toulouse, Toulouse, France. 9. Department of Urology, University Hospital of Lyon, Lyon, France. 10. APHP Department of Urology, Bicetre University Hospital, Paris Saclay University, Le Kremlin Bicetre, France. 11. Department of Urology, University Hospital of Rouen, Rouen, France. 12. Department of Urology, Hospital Saint Joseph, Paris, France. 13. Department of Urology, University Hospital of Strasbourg, Strasbourg, France. 14. Department of Urology, Institut Paoli-Calmettes, Marseille, France. 15. Department of Urology, University Hospital of Grenoble, Grenoble, France. 16. Department of Urology, University Hospital of Nice, Nice, France. 17. Department of Urology, University Hospital of Caen, Caen, France. 18. Department of Urology, University Hospital of Poitiers, Poitiers, France. 19. Sorbonne Université, GRC n°5, AP-HP, Tenon Hospital, 75020, Paris, France. 20. Urology Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France. 21. Department of Urology, University Hospital of Marseille, Marseille, France. 22. Department of Urology, University Hospital of Reims, Reims, France. 23. Department of Urology, Hospital of Mont-de-Marsan, Mont-de-Marsan, France. 24. Department of Urology, University Hospital of Bordeaux, Bordeaux, France. 25. Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Hôpital Pitié-Salpêtrière, Urology, F-75013, Paris, France. morgan.roupret@aphp.fr.
Abstract
BACKGROUND: The prognostic impact of renal cell carcinoma (RCC) morphotype remains unclear in patients who undergo partial nephrectomy (PN). Our objective was to determine the risk factors for recurrence after PN, including RCC morphotype. METHODS: Patients with RCC who had undergone PN were extracted from the prospective, national French database, UroCCR. Patients with genetic predisposition, bilateral or multiple tumours, and those who had undergone secondary totalization were excluded. Primary endpoint was 5-year, recurrence-free survival (RFS), and secondary endpoint was overall survival (OS). Risk factors for recurrence were assessed by multivariable Cox regression analysis. RESULTS: Overall, 2,767 patients were included (70% male; median age: 61 years [interquartile range (IQR) 51-69]). Most (71.5%) of the PN procedures were robot-assisted. Overall, 2,573 (93.0%) patients were recurrence free, and 74 died (2.7%). Five-year RFS was 84.9% (IQR 82.4-87.4). A significant difference in RFS was observed between RCC morphotypes (p < 0.001). Surgical margins (hazard ratio [HR] = 2.0 [95% confidence interval (CI): 1.3-3.2], p < 0.01), pT stage >1 (HR = 2.6 [95% CI: 1.8-3.7], p < 0.01]) and Fuhrmann grade >2 (HR = 1.9 [95% CI: 1.4-2.6], p < 0.001) were risk factors for recurrence, whereas chromophobe subtype was a protective factor (HR = 0.08 [95% CI: 0.01-0.6], p = 0.02). Five-year OS was 94.0% [92.4-95.7], and there were no significant differences between RCC subgroups (p = 0.06). The main study limitation was its design (multicentre national database), which may be responsible for declarative bias. CONCLUSIONS: Chromophobe morphotype was significantly associated with better RFS in RCC patients who underwent PN. Conversely, pT stage, Fuhrman group and positive surgical margins were risk factors for recurrence.
BACKGROUND: The prognostic impact of renal cell carcinoma (RCC) morphotype remains unclear in patients who undergo partial nephrectomy (PN). Our objective was to determine the risk factors for recurrence after PN, including RCC morphotype. METHODS: Patients with RCC who had undergone PN were extracted from the prospective, national French database, UroCCR. Patients with genetic predisposition, bilateral or multiple tumours, and those who had undergone secondary totalization were excluded. Primary endpoint was 5-year, recurrence-free survival (RFS), and secondary endpoint was overall survival (OS). Risk factors for recurrence were assessed by multivariable Cox regression analysis. RESULTS: Overall, 2,767 patients were included (70% male; median age: 61 years [interquartile range (IQR) 51-69]). Most (71.5%) of the PN procedures were robot-assisted. Overall, 2,573 (93.0%) patients were recurrence free, and 74 died (2.7%). Five-year RFS was 84.9% (IQR 82.4-87.4). A significant difference in RFS was observed between RCC morphotypes (p < 0.001). Surgical margins (hazard ratio [HR] = 2.0 [95% confidence interval (CI): 1.3-3.2], p < 0.01), pT stage >1 (HR = 2.6 [95% CI: 1.8-3.7], p < 0.01]) and Fuhrmann grade >2 (HR = 1.9 [95% CI: 1.4-2.6], p < 0.001) were risk factors for recurrence, whereas chromophobe subtype was a protective factor (HR = 0.08 [95% CI: 0.01-0.6], p = 0.02). Five-year OS was 94.0% [92.4-95.7], and there were no significant differences between RCC subgroups (p = 0.06). The main study limitation was its design (multicentre national database), which may be responsible for declarative bias. CONCLUSIONS: Chromophobe morphotype was significantly associated with better RFS in RCC patients who underwent PN. Conversely, pT stage, Fuhrman group and positive surgical margins were risk factors for recurrence.
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