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Long-term oncological outcomes of cystic renal cell carcinoma according to the Bosniak classification

  • R. BoissierEmail author
  • I. Ouzaid
  • F. X. Nouhaud
  • Z. Khene
  • C. Dariane
  • S. Chkir
  • S. Chelly
  • A. Giwerc
  • C. Allenet
  • J. B. Lefrancq
  • P. Gimel
  • T. Bodin
  • N. Rioux-Leclercq
  • J. M. Correas
  • L. Albiges
  • J. F. Hetet
  • P. Bigot
  • J. C. Bernhard
  • J. A. Long
  • A. Mejean
  • K. Bensalah
  • for the AFU Committee of Urological Oncology
Urology - Original Paper
  • 30 Downloads

Abstract

Objectives

To evaluate the prognostic role of the Bosniak classification on the long-term oncological outcomes of cystic renal cell carcinomas.

Material and method

In a national multicentric retrospective study, we included patients treated surgically for localized cystic RCC from 2000 to 2010. Patients with a follow-up of less than 4 years, benign tumors, and ablative treatments were excluded. The primary outcome was disease-free survival.

Results

152 patients met the inclusion criteria: Bosniak II (6%), III (53%), IV (41%), with a median follow-up of 61 (12–179) months. Characteristics of the population and the tumors were [median, (min–max)] age 57 (25–84) years old, tumor size 43 mm (20–280), RENAL score 7 (4–12), PADUA score 8 (5–14). Treatments were 55% partial nephrectomy, 45% radical nephrectomy, 74% open surgery, and 26% laparoscopy. In pathological report, cystic RCC were mainly of low grade (1–2, 77%) and low stage (pT1, 81%). The two main histological subtypes were conventional (56%) and papillary (23%) RCC. Staging at presentation and histological characteristics were similar between Bosniak III and IV, except for high grade which was more common in Bosniak IV (12 vs 36%, p < 0.01). The Bosniak classification was not predictive of the recurrence, as 5- and 10-year disease-free survival were similar in Bosniak III and IV (92% vs 92% and 84% vs 83%, p = 0.60).

Conclusion

The Bosniak classification is predictive of the risk of malignancy but not of the oncological prognosis. Regardless of the initial Bosniak categories, almost all cystic RCCs were of low stage/grade and had low long-term recurrence rate.

Keywords

Renal cell carcinoma Complex renal cyst Bosniak 

Notes

Author contributions

RB had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Protocol/project development: Boissier, Bensalah. Data collection or management: Chkir. Chelly, Dariane, Khene, Giwerc, Allenet, Lefrancq, Gimel, Hetet. Data analysis: Boissier, Bensalah. Manuscript writing/editing: Boissier. Other (please specify briefly using 1 to 5 words): Critical revision of the manuscript for important intellectual content: Nouhaud, Bigot, Bernhard, Long, Gimel, Bodin, Ouzaid, Rioux-Leclercq, Correas, Albigès, Mejean.

Compliance with ethical standards

Conflict of interest

Authors reported no conflict of interest regarding this study.

Research involving human participants and/or animals

All included patients had locally signed a consent for the use of clinical and follow-up data for research purposes. The study was approved by the ethics committee of Association Francaise d’Urologie.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • R. Boissier
    • 1
    Email author
  • I. Ouzaid
    • 2
  • F. X. Nouhaud
    • 3
  • Z. Khene
    • 4
  • C. Dariane
    • 5
  • S. Chkir
    • 1
  • S. Chelly
    • 6
  • A. Giwerc
    • 3
  • C. Allenet
    • 7
  • J. B. Lefrancq
    • 8
  • P. Gimel
    • 9
  • T. Bodin
    • 10
  • N. Rioux-Leclercq
    • 11
  • J. M. Correas
    • 12
  • L. Albiges
    • 13
  • J. F. Hetet
    • 14
  • P. Bigot
    • 6
  • J. C. Bernhard
    • 7
  • J. A. Long
    • 8
  • A. Mejean
    • 5
  • K. Bensalah
    • 4
  • for the AFU Committee of Urological Oncology
  1. 1.Department of Urology and Kidney Transplantation, Conception Academic HospitalAix-Marseille UniversityMarseilleFrance
  2. 2.Urology DepartmentBichat—Claude-BernardParisFrance
  3. 3.Urology DepartmentRouen University HospitalRouenFrance
  4. 4.Urology DepartmentRennes University HospitalRennesFrance
  5. 5.Urology DepartmentGeorges Pompidou University HospitalParisFrance
  6. 6.Urology DepartmentAngers University HospitalAngersFrance
  7. 7.Urology DepartmentBordeaux University HospitalBordeauxFrance
  8. 8.Urology DepartmentGrenoble University HospitalLa TroncheFrance
  9. 9.Urology DepartmentMedipoleCabestanyFrance
  10. 10.Urology DepartmentSaint-Joseph HospitalMarseilleFrance
  11. 11.Pathology DepartmentRennes University HospitalRennesFrance
  12. 12.Radiology DepartmentGeorges Pompidou University HospitalParisFrance
  13. 13.Oncology DepartmentGustave Roussy InstituteParisFrance
  14. 14.Urology DepartmentClinique Jules VerneNantesFrance

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