Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness

Shomik Sengupta, Christine M. Lohse, Bradley C. Leibovich, Igor Frank, R. Houston Thompson, W. Scott Webster, Horst Zincke, Michael L. Blute, John C. Cheville, Eugene D Kwon

Research output: Contribution to journalArticle

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Abstract

BACKGROUND. Prognostic markers for renal cell carcinoma (RCC), such as patient symptoms, tumor stage, tumor size, and tumor grade, are useful for determining appropriate follow-up and selecting patients for adjuvant therapy. Histologic coagulative tumor necrosis, also reported to be a prognostic marker for RCC, has not previously been extensively described or investigated. Hence, the objective of the current study was to characterize tumor necrosis as a prognostic feature of RCC. METHODS. The authors of the current study identified 3009 patients treated surgically for RCC between 1970 and 2002 from the Mayo Clinic Nephrectomy Registry (Rochester, MN). Associations of tumor necrosis with clinical, laboratory, and pathologic features were examined with chi-square, Fisher exact test, and Wilcoxon rank-sum tests. Cancer-specific survival was estimated with the Kaplan-Meier method, and associations with outcome were assessed with Cox proportional hazard models. RESULTS. Tumor necrosis was present in 690 of 2445 (28%) clear cell, 196 of 421 (47%) papillary, and 28 of 143 (20%) chromophobe RCCs. The risk ratio for death from RCC in patients with necrotic compared with nonnecrotic tumors was 5.27 (95% confidence interval [CI]: 4.56-6.09; P < 0.001) for clear cell, 4.20 (CI: 165-10.68; P < 0.001) for chromophobe, and 1.49 (CI: 0.81-2.74; P = 0.199) for papillary RCC. The survival difference for clear cell RCC persisted even after multivariate adjustment for tumor stage, size, and grade (risk ratio 1.90; P < 0.001). CONCLUSIONS. Histologic coagulative tumor necrosis is an independent predictor of outcome for clear cell and chromophobe RCC, and it should be routinely reported and used in clinical assessment.

Original languageEnglish (US)
Pages (from-to)511-520
Number of pages10
JournalCancer
Volume104
Issue number3
DOIs
StatePublished - Aug 1 2005

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Renal Cell Carcinoma
Necrosis
Neoplasms
Confidence Intervals
Nonparametric Statistics
Odds Ratio
Survival
Nephrectomy
Proportional Hazards Models
Registries

Keywords

  • Chromophobe
  • Clear cell
  • Coagulative tumor necrosis
  • Histologic subtype
  • Necrosis
  • Papillary
  • Renal cell carcinoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Sengupta, S., Lohse, C. M., Leibovich, B. C., Frank, I., Thompson, R. H., Webster, W. S., ... Kwon, E. D. (2005). Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness. Cancer, 104(3), 511-520. https://doi.org/10.1002/cncr.21206

Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness. / Sengupta, Shomik; Lohse, Christine M.; Leibovich, Bradley C.; Frank, Igor; Thompson, R. Houston; Webster, W. Scott; Zincke, Horst; Blute, Michael L.; Cheville, John C.; Kwon, Eugene D.

In: Cancer, Vol. 104, No. 3, 01.08.2005, p. 511-520.

Research output: Contribution to journalArticle

Sengupta, S, Lohse, CM, Leibovich, BC, Frank, I, Thompson, RH, Webster, WS, Zincke, H, Blute, ML, Cheville, JC & Kwon, ED 2005, 'Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness', Cancer, vol. 104, no. 3, pp. 511-520. https://doi.org/10.1002/cncr.21206
Sengupta S, Lohse CM, Leibovich BC, Frank I, Thompson RH, Webster WS et al. Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness. Cancer. 2005 Aug 1;104(3):511-520. https://doi.org/10.1002/cncr.21206
Sengupta, Shomik ; Lohse, Christine M. ; Leibovich, Bradley C. ; Frank, Igor ; Thompson, R. Houston ; Webster, W. Scott ; Zincke, Horst ; Blute, Michael L. ; Cheville, John C. ; Kwon, Eugene D. / Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness. In: Cancer. 2005 ; Vol. 104, No. 3. pp. 511-520.
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abstract = "BACKGROUND. Prognostic markers for renal cell carcinoma (RCC), such as patient symptoms, tumor stage, tumor size, and tumor grade, are useful for determining appropriate follow-up and selecting patients for adjuvant therapy. Histologic coagulative tumor necrosis, also reported to be a prognostic marker for RCC, has not previously been extensively described or investigated. Hence, the objective of the current study was to characterize tumor necrosis as a prognostic feature of RCC. METHODS. The authors of the current study identified 3009 patients treated surgically for RCC between 1970 and 2002 from the Mayo Clinic Nephrectomy Registry (Rochester, MN). Associations of tumor necrosis with clinical, laboratory, and pathologic features were examined with chi-square, Fisher exact test, and Wilcoxon rank-sum tests. Cancer-specific survival was estimated with the Kaplan-Meier method, and associations with outcome were assessed with Cox proportional hazard models. RESULTS. Tumor necrosis was present in 690 of 2445 (28{\%}) clear cell, 196 of 421 (47{\%}) papillary, and 28 of 143 (20{\%}) chromophobe RCCs. The risk ratio for death from RCC in patients with necrotic compared with nonnecrotic tumors was 5.27 (95{\%} confidence interval [CI]: 4.56-6.09; P < 0.001) for clear cell, 4.20 (CI: 165-10.68; P < 0.001) for chromophobe, and 1.49 (CI: 0.81-2.74; P = 0.199) for papillary RCC. The survival difference for clear cell RCC persisted even after multivariate adjustment for tumor stage, size, and grade (risk ratio 1.90; P < 0.001). CONCLUSIONS. Histologic coagulative tumor necrosis is an independent predictor of outcome for clear cell and chromophobe RCC, and it should be routinely reported and used in clinical assessment.",
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AU - Sengupta, Shomik

AU - Lohse, Christine M.

AU - Leibovich, Bradley C.

AU - Frank, Igor

AU - Thompson, R. Houston

AU - Webster, W. Scott

AU - Zincke, Horst

AU - Blute, Michael L.

AU - Cheville, John C.

AU - Kwon, Eugene D

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N2 - BACKGROUND. Prognostic markers for renal cell carcinoma (RCC), such as patient symptoms, tumor stage, tumor size, and tumor grade, are useful for determining appropriate follow-up and selecting patients for adjuvant therapy. Histologic coagulative tumor necrosis, also reported to be a prognostic marker for RCC, has not previously been extensively described or investigated. Hence, the objective of the current study was to characterize tumor necrosis as a prognostic feature of RCC. METHODS. The authors of the current study identified 3009 patients treated surgically for RCC between 1970 and 2002 from the Mayo Clinic Nephrectomy Registry (Rochester, MN). Associations of tumor necrosis with clinical, laboratory, and pathologic features were examined with chi-square, Fisher exact test, and Wilcoxon rank-sum tests. Cancer-specific survival was estimated with the Kaplan-Meier method, and associations with outcome were assessed with Cox proportional hazard models. RESULTS. Tumor necrosis was present in 690 of 2445 (28%) clear cell, 196 of 421 (47%) papillary, and 28 of 143 (20%) chromophobe RCCs. The risk ratio for death from RCC in patients with necrotic compared with nonnecrotic tumors was 5.27 (95% confidence interval [CI]: 4.56-6.09; P < 0.001) for clear cell, 4.20 (CI: 165-10.68; P < 0.001) for chromophobe, and 1.49 (CI: 0.81-2.74; P = 0.199) for papillary RCC. The survival difference for clear cell RCC persisted even after multivariate adjustment for tumor stage, size, and grade (risk ratio 1.90; P < 0.001). CONCLUSIONS. Histologic coagulative tumor necrosis is an independent predictor of outcome for clear cell and chromophobe RCC, and it should be routinely reported and used in clinical assessment.

AB - BACKGROUND. Prognostic markers for renal cell carcinoma (RCC), such as patient symptoms, tumor stage, tumor size, and tumor grade, are useful for determining appropriate follow-up and selecting patients for adjuvant therapy. Histologic coagulative tumor necrosis, also reported to be a prognostic marker for RCC, has not previously been extensively described or investigated. Hence, the objective of the current study was to characterize tumor necrosis as a prognostic feature of RCC. METHODS. The authors of the current study identified 3009 patients treated surgically for RCC between 1970 and 2002 from the Mayo Clinic Nephrectomy Registry (Rochester, MN). Associations of tumor necrosis with clinical, laboratory, and pathologic features were examined with chi-square, Fisher exact test, and Wilcoxon rank-sum tests. Cancer-specific survival was estimated with the Kaplan-Meier method, and associations with outcome were assessed with Cox proportional hazard models. RESULTS. Tumor necrosis was present in 690 of 2445 (28%) clear cell, 196 of 421 (47%) papillary, and 28 of 143 (20%) chromophobe RCCs. The risk ratio for death from RCC in patients with necrotic compared with nonnecrotic tumors was 5.27 (95% confidence interval [CI]: 4.56-6.09; P < 0.001) for clear cell, 4.20 (CI: 165-10.68; P < 0.001) for chromophobe, and 1.49 (CI: 0.81-2.74; P = 0.199) for papillary RCC. The survival difference for clear cell RCC persisted even after multivariate adjustment for tumor stage, size, and grade (risk ratio 1.90; P < 0.001). CONCLUSIONS. Histologic coagulative tumor necrosis is an independent predictor of outcome for clear cell and chromophobe RCC, and it should be routinely reported and used in clinical assessment.

KW - Chromophobe

KW - Clear cell

KW - Coagulative tumor necrosis

KW - Histologic subtype

KW - Necrosis

KW - Papillary

KW - Renal cell carcinoma

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