W. Artibani

Use of the University of California Los Angeles integrated staging system to predict survival in renal cell carcinoma: an international multicenter study.

PURPOSEnTo evaluate ability of the University of California Los Angeles Integrated Staging System (UISS) to stratify patients with localized and metastatic renal cell carcinoma (RCC) into risk groups in an international multicenter study.nnnPATIENTS AND METHODSn4,202 patients from eight international academic centers were classified according to the UISS, which combines TNM stage, Fuhrman grade, and Eastern Cooperative Oncology Group performance status. Distribution of the UISS categories was assessed in the overall population and in each center.nnnRESULTSnThe UISS stratified both localized and metastatic RCC into three different risk groups (P <.001). For localized RCC, the 5-year survival rates were 92%, 67%, and 44% for low-, intermediate-, and high-risk groups, respectively. A trend toward a higher risk of death was observed in all centers for increasing UISS risk category. For metastatic RCC, the 3-year survival rates were 37%, 23%, and 12% for low-, intermediate-, and high-risk groups, respectively; in 6 of 8 centers, a trend toward a higher risk of death was observed for increasing UISS risk category. A greater variability in survival rates among centers was observed for high-risk patients.nnnCONCLUSIONnThis study defines the general applicability of the UISS for predicting survival in patients with RCC. The UISS is an accurate predictor of survival for patients with localized RCC applicable to external databases. Although the UISS may be useful for patients with metastatic RCC, it may be less accurate in this subset of patients due to the heterogeneity of patients and treatments.

45 Chromophobe renal cell carcinoma: A comprehensive analysis of 104 cases from a multicentric European database

bjectives. To analyze the clinical behavior of chromophobe renal cell carcinoma (CRCC), we retrospecively evaluated the data from six European centers. In 1985, CRCC was identified as a new RCC histologic ubtype. Because of its low frequency, only few large CRCC series are available. ethods. We created a renal cancer database including 3228 patients who underwent surgery between 986 and 2002 in six European centers. The relevant clinical and pathologic data were extracted from the linical charts at each institution and collected into a unique database. esults. Of the 3228 patients, 104 (3.2%) affected by CRCC were identified. The mean age at diagnosis was 7.6 years (range 22 to 83). Of the 104 patients, 51 (49%) were men and 53 (51%) were women. The mean umor size was 6.4 3.6 cm. An incidental diagnosis accounted for 61.5% of the cases. Radical nephrecomy was performed in 88 patients (85%). After a median follow-up of 38 months (mean 44, range 1 to 153), o local recurrence was observed. The 5-year overall survival rate for CRCC was 81%. Of the 104 patients, (4.8%) and 9 (8.6%) died of unrelated causes and renal cancer, respectively. onclusions. Our series confirmed a favorable outcome for the CRCC subtype with little local aggressiveess and a low propensity for progression and death from cancer. UROLOGY 65: 681–686, 2005.

557 COLLECTING DUCT RENAL CELL CARCINOMA: A MATCHED ANALYSIS OF 41 CASES

OBJECTIVESnCollecting duct renal cell carcinoma (CDRCC) is a rare but reportedly aggressive histologic subtype. We assessed the stage and histologic features of patients with CDRCC and compared cancer-specific mortality in CDRCC and matched patients with clear-cell renal cell carcinoma (CRCC).nnnMETHODSnForty-one (0.6%) patients with CDRCC and 5246 CRCC patients were identified within a cohort of 6608 patients treated with either radical or partial nephrectomy for renal cancer. Within the 5246 CRCC cases, 105 were matched with CDRCC cases for grade, tumour size, and T, N, and M stages. Kaplan-Meier and life table analyses addressed RCC-specific survival.nnnRESULTSnOf all CDRCC patients, 76% had pT3 disease at nephrectomy versus 37% for those with CRCC. The predominant Fuhrman grades were III (56%) and IV (22%) in CDRCC versus II (42%) and III (28%) for CRCC. Moreover, 49% of CDRCC patients were pN1-2 versus 8% for CRCC. Of CDRCC patients 19% had distant metastases at nephrectomy versus 14% for CRCC. Finally, 73% of CDRCC patients had either local or systemic symptoms versus 56% for CRCC. After matching, the RCC-specific mortality of CDRCC patients was no different from that for CRCC patients (RR=1.1; p=0.8). One- and 5-yr CDRCC-specific survival rates were 86% and 48%, respectively, versus 86% and 57% for matched CRCC controls.nnnCONCLUSIONSnCDRCC patients present with more advanced stage and with more aggressive disease compared with CRCC patients. After nephrectomy, when CDRCC cases were matched with CRCC, the same cause-specific survival was seen.

Prognostic Value of Histologic Subtypes in Renal Cell Carcinoma: A Multicenter Experience

PURPOSEnTo analyze to what extent histologic subtype is of prognostic importance in renal cell carcinoma based on a large, international, multicenter experience.nnnPATIENTS AND METHODSnFour thousand sixty-three patients from eight international centers were included in this retrospective study. Histologic subtype (1997 International Union Against Cancer [UICC] criteria of tumor response), age, sex, TNM stage, Fuhrman grade, tumor size, Eastern Cooperative Oncology Goup performance status (ECOG PS), and overall survival were determined in all cases. The prognostic values of clear cell, papillary, and chromophobe histologic features were assessed by uni- and multivariate analysis using the Kaplan-Meier method and Cox model, respectively.nnnRESULTSnClear cell, papillary, and chromophobe carcinomas accounted for 3,564 (87.7%), 396 (9.7%) and 103 (2.5%) cases, respectively. In univariate analysis, a trend toward a better survival was observed when clear cell, papillary, and chromophobe histologies were considered prognostic categories (log-rank P = .0007). However, in multivariate analysis, TNM stage, Fuhrman grade and ECOG PS, but not histology, were retained as independent prognostic variables (P < .001).nnnCONCLUSIONnThe stratification in three main renal cell carcinoma histologic subtypes as defined by the 1997 UICC-American Joint Committee on Cancer consensus should not be considered a major prognostic variable comparable to TNM stage, Fuhrman grade and ECOG PS.

IS PERCUTANEOUS NEPHROLITHOTOMY A SAFE AND EFFECTIVE PROCEDURE FOR TREATMENT OF RENAL STONES IN CHILDREN

MATERIAL & METHODS: Percutaneous nephrolithotomy (PCNL) was performed in 30 children 1 to 17 years old (median age 12), including 14 boys (46.6%) and 16 girls (53.3%). There was a single obstructing calculus in 20 patients, while 10 had multiple calculi. The procedure was performed in 1 stage in 28 patients, and it was staged with preliminary nephrostomy in two cases. Complete anatomical and metabolic evaluation was performed in all cases. Patients were followed 1, 3 and 6 months postoperatively with a plain abdominal x-ray and renal ultrasound.