Association of microvascular and capillary-lymphatic invasion with outcome in patients with renal cell carcinoma

Manuel S. Eisenberg, John C. Cheville, R. Houston Thompson, Dharam Kaushik, Christine M. Lohse, Stephen A. Boorjian, Brian Costello, Bradley C. Leibovich

Research output: Contribution to journalArticle

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Abstract

Purpose: We evaluated the association of microvascular and capillary-lymphatic invasion with patient outcome after nephrectomy for renal cell carcinoma. Materials and Methods: We identified 1,433 patients surgically treated for sporadic, unilateral renal cell carcinoma between 2001 and 2008. All specimens were reviewed by a single uropathologist for microvascular and capillary-lymphatic invasion. Associations with time to metastasis and death from renal cell carcinoma were evaluated using Cox proportional hazards models, controlling for established clinicopathological prognostic variables. Results: Microvascular invasion and capillary-lymphatic invasion were identified in 119 (11%) and 17 (2%) of the 1,103 patients with clear cell, 5 (2%) and 1 (less than 1%) of the 219 with papillary, and 1 (1%) and 0 of the 86 with chromophobe renal cell carcinoma, respectively. Median followup in survivors was 6.4 years (range 0 to 11). In clear cell renal cell carcinoma cases microvascular invasion was univariately associated with an increased risk of metastasis and cancer specific death (HR 3.5 and 3.0, respectively, each p <0.001). However, on multivariate analysis these associations were no longer statistically significant (HR 1.2, p = 0.4 and HR 1.3, p = 0.1, respectively). Capillary-lymphatic invasion remained significantly associated with an increased risk of metastasis and death on univariate analysis (HR 15.9 and 11.6) and on multivariate analysis (HR 3.2 and HR 3.1, respectively, each p <0.001). Conclusions: Microvascular invasion is associated with an increased risk of metastasis and cancer death in patients with clear cell renal cell carcinoma, although this did not remain significant after controlling for established prognostic variables. Capillary-lymphatic invasion appears to be independently associated with metastasis and cancer death even after controlling for known prognostic risk factors. However, given its rarity, this feature may prove to be of limited clinical significance.

Original languageEnglish (US)
Pages (from-to)37-43
Number of pages7
JournalJournal of Urology
Volume190
Issue number1
DOIs
StatePublished - Jul 2013

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Lymphatic Vessels
Renal Cell Carcinoma
Neoplasm Metastasis
Multivariate Analysis
Neoplasms
Nephrectomy
Proportional Hazards Models
Survivors

Keywords

  • carcinoma
  • kidney
  • lymphatic metastasis
  • microvessels
  • mortality
  • renal cell

ASJC Scopus subject areas

  • Urology

Cite this

Eisenberg, M. S., Cheville, J. C., Thompson, R. H., Kaushik, D., Lohse, C. M., Boorjian, S. A., ... Leibovich, B. C. (2013). Association of microvascular and capillary-lymphatic invasion with outcome in patients with renal cell carcinoma. Journal of Urology, 190(1), 37-43. https://doi.org/10.1016/j.juro.2013.01.044

Association of microvascular and capillary-lymphatic invasion with outcome in patients with renal cell carcinoma. / Eisenberg, Manuel S.; Cheville, John C.; Thompson, R. Houston; Kaushik, Dharam; Lohse, Christine M.; Boorjian, Stephen A.; Costello, Brian; Leibovich, Bradley C.

In: Journal of Urology, Vol. 190, No. 1, 07.2013, p. 37-43.

Research output: Contribution to journalArticle

Eisenberg, MS, Cheville, JC, Thompson, RH, Kaushik, D, Lohse, CM, Boorjian, SA, Costello, B & Leibovich, BC 2013, 'Association of microvascular and capillary-lymphatic invasion with outcome in patients with renal cell carcinoma', Journal of Urology, vol. 190, no. 1, pp. 37-43. https://doi.org/10.1016/j.juro.2013.01.044
Eisenberg, Manuel S. ; Cheville, John C. ; Thompson, R. Houston ; Kaushik, Dharam ; Lohse, Christine M. ; Boorjian, Stephen A. ; Costello, Brian ; Leibovich, Bradley C. / Association of microvascular and capillary-lymphatic invasion with outcome in patients with renal cell carcinoma. In: Journal of Urology. 2013 ; Vol. 190, No. 1. pp. 37-43.
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abstract = "Purpose: We evaluated the association of microvascular and capillary-lymphatic invasion with patient outcome after nephrectomy for renal cell carcinoma. Materials and Methods: We identified 1,433 patients surgically treated for sporadic, unilateral renal cell carcinoma between 2001 and 2008. All specimens were reviewed by a single uropathologist for microvascular and capillary-lymphatic invasion. Associations with time to metastasis and death from renal cell carcinoma were evaluated using Cox proportional hazards models, controlling for established clinicopathological prognostic variables. Results: Microvascular invasion and capillary-lymphatic invasion were identified in 119 (11{\%}) and 17 (2{\%}) of the 1,103 patients with clear cell, 5 (2{\%}) and 1 (less than 1{\%}) of the 219 with papillary, and 1 (1{\%}) and 0 of the 86 with chromophobe renal cell carcinoma, respectively. Median followup in survivors was 6.4 years (range 0 to 11). In clear cell renal cell carcinoma cases microvascular invasion was univariately associated with an increased risk of metastasis and cancer specific death (HR 3.5 and 3.0, respectively, each p <0.001). However, on multivariate analysis these associations were no longer statistically significant (HR 1.2, p = 0.4 and HR 1.3, p = 0.1, respectively). Capillary-lymphatic invasion remained significantly associated with an increased risk of metastasis and death on univariate analysis (HR 15.9 and 11.6) and on multivariate analysis (HR 3.2 and HR 3.1, respectively, each p <0.001). Conclusions: Microvascular invasion is associated with an increased risk of metastasis and cancer death in patients with clear cell renal cell carcinoma, although this did not remain significant after controlling for established prognostic variables. Capillary-lymphatic invasion appears to be independently associated with metastasis and cancer death even after controlling for known prognostic risk factors. However, given its rarity, this feature may prove to be of limited clinical significance.",
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AU - Eisenberg, Manuel S.

AU - Cheville, John C.

AU - Thompson, R. Houston

AU - Kaushik, Dharam

AU - Lohse, Christine M.

AU - Boorjian, Stephen A.

AU - Costello, Brian

AU - Leibovich, Bradley C.

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N2 - Purpose: We evaluated the association of microvascular and capillary-lymphatic invasion with patient outcome after nephrectomy for renal cell carcinoma. Materials and Methods: We identified 1,433 patients surgically treated for sporadic, unilateral renal cell carcinoma between 2001 and 2008. All specimens were reviewed by a single uropathologist for microvascular and capillary-lymphatic invasion. Associations with time to metastasis and death from renal cell carcinoma were evaluated using Cox proportional hazards models, controlling for established clinicopathological prognostic variables. Results: Microvascular invasion and capillary-lymphatic invasion were identified in 119 (11%) and 17 (2%) of the 1,103 patients with clear cell, 5 (2%) and 1 (less than 1%) of the 219 with papillary, and 1 (1%) and 0 of the 86 with chromophobe renal cell carcinoma, respectively. Median followup in survivors was 6.4 years (range 0 to 11). In clear cell renal cell carcinoma cases microvascular invasion was univariately associated with an increased risk of metastasis and cancer specific death (HR 3.5 and 3.0, respectively, each p <0.001). However, on multivariate analysis these associations were no longer statistically significant (HR 1.2, p = 0.4 and HR 1.3, p = 0.1, respectively). Capillary-lymphatic invasion remained significantly associated with an increased risk of metastasis and death on univariate analysis (HR 15.9 and 11.6) and on multivariate analysis (HR 3.2 and HR 3.1, respectively, each p <0.001). Conclusions: Microvascular invasion is associated with an increased risk of metastasis and cancer death in patients with clear cell renal cell carcinoma, although this did not remain significant after controlling for established prognostic variables. Capillary-lymphatic invasion appears to be independently associated with metastasis and cancer death even after controlling for known prognostic risk factors. However, given its rarity, this feature may prove to be of limited clinical significance.

AB - Purpose: We evaluated the association of microvascular and capillary-lymphatic invasion with patient outcome after nephrectomy for renal cell carcinoma. Materials and Methods: We identified 1,433 patients surgically treated for sporadic, unilateral renal cell carcinoma between 2001 and 2008. All specimens were reviewed by a single uropathologist for microvascular and capillary-lymphatic invasion. Associations with time to metastasis and death from renal cell carcinoma were evaluated using Cox proportional hazards models, controlling for established clinicopathological prognostic variables. Results: Microvascular invasion and capillary-lymphatic invasion were identified in 119 (11%) and 17 (2%) of the 1,103 patients with clear cell, 5 (2%) and 1 (less than 1%) of the 219 with papillary, and 1 (1%) and 0 of the 86 with chromophobe renal cell carcinoma, respectively. Median followup in survivors was 6.4 years (range 0 to 11). In clear cell renal cell carcinoma cases microvascular invasion was univariately associated with an increased risk of metastasis and cancer specific death (HR 3.5 and 3.0, respectively, each p <0.001). However, on multivariate analysis these associations were no longer statistically significant (HR 1.2, p = 0.4 and HR 1.3, p = 0.1, respectively). Capillary-lymphatic invasion remained significantly associated with an increased risk of metastasis and death on univariate analysis (HR 15.9 and 11.6) and on multivariate analysis (HR 3.2 and HR 3.1, respectively, each p <0.001). Conclusions: Microvascular invasion is associated with an increased risk of metastasis and cancer death in patients with clear cell renal cell carcinoma, although this did not remain significant after controlling for established prognostic variables. Capillary-lymphatic invasion appears to be independently associated with metastasis and cancer death even after controlling for known prognostic risk factors. However, given its rarity, this feature may prove to be of limited clinical significance.

KW - carcinoma

KW - kidney

KW - lymphatic metastasis

KW - microvessels

KW - mortality

KW - renal cell

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