Prognostic factors in a large multi-institutional series of papillary renal cell carcinoma.

OBJECTIVES • To investigate cancer-related outcomes and prognostic factors of papillary renal cell carcinoma (pRCC) in a large multicentre data set. • Oncological outcome and prognostic factors of pRCC have been limitedly evaluated in comparison with the most common RCC subtype, clear cell RCC. PATIENTS AND METHODS • From a multicentre retrospective database, including 5463 patients who were surgically treated for RCC at 16 Italian academic centres between 1995 and 2007, 577 patients with pRCC were identifi ed. • Univariable and multivariable Cox regression models were performed to identify prognostic factors predictive of recurrence-free survival (RFS) and cancer-specifi c survival (CSS) after surgery. RESULTS • At a median (interquartile range) follow-up of 39.2 (21.7 – 72) months, 81 (14%) patients had experienced disease progression and 63 (11%) patients had died from disease; the 5-year RFS estimate was 85.5%. • In multivariable analysis, pathological N stage (pooled P < 0.001), M stage (hazard ratio, 2.9; P = 0.007) and Fuhrman nuclear grade (pooled P = 0.039) were all independent predictors of RFS; the 5-year CSS estimate was 87.9%. • In Cox multivariable analysis, an independent predictive role was reconfi rmed for mode of presentation (pooled P = 0.038), pathological N stage (pooled P < 0.001), M stage (hazard ratio, 2.4; P = 0.049) and Fuhrman nuclear grade (pooled P = 0.037). CONCLUSIONS • Patients with pRCC have a low risk of tumour recurrence and cancer-related death after surgery. • Fuhrman nuclear grade was found to be a stronger predictor of both RFS and CSS, whereas only a non-statistically signifi cant trend was found for the 2009 pathological T stage.