Epidemiological and Clinico-Pathological Characteristics of Patients with Renal Carcinoma: A Single Institution Analysis of 544 Cases
Authors:
A. Poprach 1; R. Lakomý 1; I. Selingerová 2; B. Dolečková 1; O. Bílek 1; O. Slabý 1; R. Héžová 1; P. Fabian 3; M. Staník 4; T. Pavlík 5; Z. Bortlíček 5; H. Mlčochová 1; D. Tkáč 6; R. Vyzula 1; I. Kiss 1; I. Kocák 1; I. Kocáková 1; M. Svoboda 1
Authors‘ workplace:
Klinika komplexní onkologické péče, Masarykův onkologický ústav, Brno
1; Ústav matematiky a statistiky, PřF MU Brno
2; Oddělení onkologické a experimentální patologie, Masarykův onkologický ústav, Brno
3; Uroonkologické oddělení, Masarykův onkologický ústav, Brno
4; Institut biostatistiky a analýz, MU Brno
5; Farmaceutická fakulta UK v Praze, Hradec Králové
6
Published in:
Klin Onkol 2013; 26(2): 114-123
Category:
Original Articles
Overview
Background:
The incidence of renal cell carcinoma in the Czech Republic is one of the highest in the world. Curative treatment is still possible only surgically, while in the palliative treatment, partial success was reached using targeted therapies. While prognostic factors and models are commonly used in clinical practice, unfortunately, predictive biomarkers have not been found. The aim of our study was to verify the validity of selected prognostic factors on a consecutive patient cohort from the Czech population.
Patients and methods:
The patient cohort consisted of 544 patients with RCC diagnosed and/or treated at our institute from 2003 to 2010. Individual clinical and histological prognostic factors and Heng prognostic model were validated.
Results:
Median time of follow-up for our cohort was 42 months (range 0.3–326 months), median age at diagnosis was 62 years, and almost 64% of patients were men. Distribution of clinical stages was as follows: 46.5% of I, II. 10.7%, III. 13.1%, IV. 20%. 26.4% of patients in stage I–III relapsed. We diagnosed mainly clear cell (84.6%) and papillary carcinoma (9.2%). Initially, 95.8% of patients underwent surgical treatment, systemic adjuvant and palliative treatment was applied in 3.7 and 37.7% of patients, respectively. Palliative targeted therapy was received by a total of 163 patients (30%). In first-line targeted therapy, the following median TTP was reached (in months): 10.8 for sunitinib, 6.3 for sorafenib and 5.2 months for immunotherapy. The most significant prognostic factors (p < 0.00001) were: stage of disease (HR = 9.61), size of the primary tumor (HR = 5.83), lymph nodes (HR = 8.26), presence of sarcomatoid tumor sections in the tumor (HR = 7.29), and tumor grade (HR = 4.0). Besides these, we also confirmed the prognostic importance of presence of eosinophilic granulations in the tumor (HR = 1.91, p = 0.02). When applying the Heng prognostic model, we achieved similar results for patients treated with targeted therapies.
Conclusion:
The obtained epidemiological and clinico-pathological data are consistent with previously published data. These prognostic factors can be used for a differentiated approach to patients with RCC, both for establishing follow-up plan for patients after surgery as well as indication for targeted therapies.
Key words:
renal carcinoma – immunotherapy – targeted therapy – sunitinib – sorafenib – prognosis
Sources
1. Dušek L, Mužík J, Kubásek M et al. Epidemiologie zhoubných nádorů v České republice [online]. Masarykova univerzita 2005. [cit. 2013-3-25]. http://www.svod.cz.
2. Poprach A, Bortlíček Z, Büchler T et al. Patients with advanced and metastatic renal cell carcinoma treated with targeted therapy in the Czech Republic: twenty cancer centres, six agents, one database. Med Oncol 2012; 29(5): 3314–3320.
3. Escudier B, Eisen T, Porta C et al. ESMO Guidelines Working Group. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; 23 (Suppl 7): vii65–vii71.
4. NCCN Clinical practice guidelines in oncology. Kidney cancer V.2.2012 [online]. J Natl Compr Cancer Netw 2012. [cit. 2012-10-16]. www.nccn.org.
5. Nanus DM, Garino A, Milowsky MI et al. Active chemotherapy for sarcomatoid and rapidly progressing renal cell carcinoma. Cancer 2004; 101(7): 1545–1551.
6. Leibovich BC, Blute ML, Cheville JC et al. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer 2003; 97(7): 1663–1671.
7. Patard JJ, Kim HL, Lam JS et al. Use of the University of California Los Angeles integrated staging system to predict survival in renal cell carcinoma: an international multicenter study. J Clin Oncol 2004; 22(16): 3316–3322.
8. Motzer RJ, Mazumdar M, Bacik J et al. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 1999; 17(8): 2530–2540.
9. Motzer RJ, Bacik J, Murphy BA et al. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 2002; 20(1): 289–296.
10. Motzer RJ, Bacik J, Schwartz LH et al. Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma. J Clin Oncol 2004; 22(3): 454–463.
11. Motzer RJ, Bukowski RM, Figlin RA et al. Prognostic nomogram for sunitinib in patients with metastatic renal cell carcinoma. Cancer 2008; 113(7): 1552–1558.
12. Heng DY, Xie W, Regan MM et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 2009; 27(34): 5794–5799.
13. Eisenhauer EA, Therasse P, Bogaerts J et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45(2): 228–247.
14. Sobin LH, Wittekind C. TNM Classification of Malignant Tumours. UICC International Union Against Cancer 6th Ed. Wiley-Blackwell 2002, česká verze 2004: 161–166.
15. Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 1982; 6(7): 655–663.
16. Antonelli A, Zani D, Cozzoli A et al. Nephron-sparing surgery versus radical nephrectomy in the treatment of renal cell carcinoma up to 7 cm. Urologia 2007; 74(3): 173–179.
17. Bedke J, Pritsch M, Buse S et al. Prognostic stratification of localized renal cell carcinoma by tumor size. J Urol 2008; 180(1): 62–67.
18. Moch H, Artibani W, Delahunt B et al. Reassessing the current UICC/AJCC TNM staging for renal cell carcinoma. Eur Urol 2009; 56(4): 636–643.
19. Karakiewicz PI, Trinh QD, Bhojani N et al. Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease: prognostic indicators of disease-specific survival. Eur Urol 2007; 51(6): 1616–1624. Epub 2006 Dec 14.
20. Yang XJ, Takahashi M, Schafernak KT et al. Does ‚granular cell‘ renal cell carcinoma exist? Molecular and histological reclassification. Histopathology 2007; 50(5): 678–680.
21. Kanamaru H, Mori H, Sasaki M et al. Histologic characteristics of renal cell carcinomas with lymph node metastasis. Int J Urol 1997; 4(5): 451–455.
22. Podhola M. Karcinom ledvin dospělých. Onkologie 2009; 3(2): 80–82.
23. Kim H, Cho NH, Kim DS et al. Genitourinary Pathology Study Group of the Korean Society of Pathologists. Renal cell carcinoma in South Korea: a multicenter study. Hum Pathol 2004; 35(12): 1556–1563.
24. Bromwich EJ, McArdle PA, Canna K et al. The relationship between T-lymphocyte infiltration, stage, tumour grade and survival in patients undergoing curative surgery for renal cell cancer. Br J Cancer 2003; 89(10): 1906–1908.
25. Motzer RJ, Hutson TE, Tomczak P et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol 2009; 27(22): 3584–3590. Epub 2009 Jun 1.
26. Escudier B, Eisen T, Stadler WM et al. Sorafenib for treatment of renal cell carcinoma: Final efficacy and safety results of the phase III treatment approaches in renal cancer global evaluation trial. J Clin Oncol 2009; 27(20): 3312–3318.
27. Bono P, Rautiola J, Utriainen T et al. Hypertension as predictor of sunitinib treatment outcome in metastatic renal cell carcinoma. Acta Oncol 2011; 50(4): 569–573. Epub 2011 Jan 5.
28. Puzanov I, Michaelson MD, Cohen DP et al. Evaluation of hand-foot syndrome (HFS) as a potential biomarker of sunitinib (SU) efficacy in patients (pts) with metastatic renal cell carcinoma (mRCC) and gastrointestinal stromal tumor (GIST). J Clin Oncol 2011; 29 (Suppl 7); abstr e21113.
29. Schmidinger M, Vogl UM, Bojic M et al. Hypothyroidism in patients with renal cell carcinoma: blessing or curse? Cancer 2011; 117(3): 534–544. doi: 10.1002//cncr.25422. Epub 2010 Sep 15.
30. Poprach A, Pavlik T, Melichar B et al. Czech Renal Cancer Cooperative Group. Skin toxicity and efficacy of sunitinib and sorafenib in metastatic renal cell carcinoma: a national registry-based study. Ann Oncol 2012; 23(12): 3137–3143. Epub 2012 Jun 13.
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