Outcomes of curative nephrectomy against renal cell carcinoma based on a central pathological review of 914 specimens from the era of cytokine treatment

• Published in: International journal of clinical oncology Vol. 20; no. 6; pp. 1161 - 1170
• Main Authors: Ito, Noriyuki, Kojima, Shinsuke, Teramukai, Satoshi, Mikami, Yoshiki, Ogawa, Osamu, Kamba, Tomomi
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.12.2015; Springer Nature B.V
• Subjects: Aged; Cancer Research; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - surgery; Cytokines; Cytokines - therapeutic use; Disease-Free Survival; Female; Humans; Kidney cancer; Kidney Neoplasms - drug therapy; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Staging; Nephrectomy; Oncology; Original Article; Pathology; Studies; Surgical Oncology; Survival Rate; Tumor Burden; Central pathology; Renal cell carcinoma; Prognostic factors; Cytokine; Histological subtypes
• DOI: 10.1007/s10147-015-0840-5
• ISSN: 1341-9625

Background The purpose of this study was to determine the state of modern practice with regard to renal cell carcinoma (RCC) outcomes and to assess the effects on survival of such clinical and pathological factors such as histological subtype (HS) and nuclear grade by conducting a central pathological review based on the current World Health Organization classification and the staging system of the American Joint Committee on Cancer/Union for International Cancer Control. Methods We collected glass slides and clinical data sets for 914 cases of RCC treated with curative nephrectomy from 1995 to 2000. Overall (OS), cancer-specific (CSS), and relapse-free (RFS) survival were compared for HS and nuclear grades determined by a central pathology review board comprising 5 board-certified pathologists, pathological staging, and a variety of clinical factors. Results The 5 and 7-year CSS in this study were 96 and 93 %, respectively, values superior to those reported in Western countries. Concordance between the original and reviewed HS and nuclear grades were 90.9 and 21.1 %, respectively. HS correlated with OS ( P  = 0.043) but was not an independent prognostic factor in the multivariate analysis ( P  = 0.820). Tumor size, Fuhrman grade, and infiltration type were common independent prognostic factors for OS, CSS, and RFS. Conclusions This study revealed RCC outcomes in the era of cytokine treatment for metastasis. Central pathological review is an essential component of a multicenter study with long-term follow-up. Tumor size, Fuhrman grade, and infiltration type had much greater effects than HS on survival after curative nephrectomy.