Skip to main content
SpringerLink
Log in

Die postoperative Prognose des chromophoben Nierenzellkarzinoms

Eine vergleichende Analyse anhand der multinationalen CORONA-Datenbank

Postoperative prognosis of chromophobic renal cell carcinoma

Comparative analysis of the multinational CORONA database

  • Originalien
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Der chromophobe Subtyp (chNZK) stellt die dritthäufigste histologische Variante des Nierenzellkarzinoms (NZK) dar. Aufgrund der relativen Seltenheit dieses Subtyps liegt derzeit nur eine Arbeit vor, die eine gezielte Analyse der klinischen und histopathologischen Kriterien sowie des Überlebens von mehr als 200 Patienten mit chNZK leistet.

Material und Methode

Die Datenbank dieser multinationalen Studie bildeten 6234 NZK-Patienten aus 11 Zentren, die durch (partielle) Nephrektomie behandelt wurden. 259 Patienten mit chNZK (4,2 %) wurden hinsichtlich ihrer klinischen und histopathologischen Kriterien 4994 Patienten mit klarzelligem Subtyp (80,1 %) gegenübergestellt und stellten somit die Studiengruppe dieser retrospektiven Untersuchung dar. Anhand von multivariablen Cox-Regressionsanalysen wurde der unabhängige Einfluss des chromophoben Subtyps auf das tumorspezifische Überleben und Gesamtüberleben geprüft. Der mediane Beobachtungszeitraum betrug 59 („interquartile range“: 29–106) Monate.

Ergebnisse

Patienten mit chNZK waren im Vergleich zu Patienten mit klarzelligem Subtyp signifikant jünger (60 vs. 63,2 Jahre; p < 0,001), häufiger weiblichen Geschlechts (50 vs. 41 %; p = 0,005) und zeigten seltener simultane Fernmetastasen (3,5 vs. 7,1 %; p = 0,023). Bei vergleichbarer medianer Tumorgröße lagen bei Patienten mit chNZK in 24,7 % Tumorstadien ≥ pT3 vor (im Vergleich zu 30,5 % bei klarzelligem Subtyp; p = 0,047). Es ging vom histologischen Subtyp kein unabhängiger Einfluss auf die tumorspezifische Mortalität [Hazard Ratio (HR) = 0,88; p = 0,515] und Gesamtmortalität (HR = 1,00; p = 0,998) aus. Die C-Indizes für die Cox-Modelle betrugen 0,86 bzw. 0,77. Neben den klinischen Kriterien Alter, Geschlecht und M-Stadium wiesen die histologischen Variablen pTN-Stadium, Grading und Tumorgröße einen signifikanten Einfluss auf beide Endpunkte auf.

Schlussfolgerungen

Patienten mit chNZK und kNZK unterscheiden sich signifikant in der Verteilung der klinischen und histopathologischen Kriterien. Im Vergleich besteht für Patienten mit chNZK in der univariablen Analyse des tumorspezifischen Überlebens ein signifikanter Vorteil, der sich nach Modelladjustierung mit den etablierten Risikofaktoren nivelliert.

Abstract

Background

The chromophobe subtype represents the third most common histological subtype of renal cell carcinoma (chRCC). Due to the rarity of this subtype only one publication regarding the specific analysis of clinical and histopathological criteria as well as survival analysis of more than 200 patients with chRCC is known to date.

Materials and methods

A total of 6,234 RCC patients from 11 centres who were treated by (partial) nephrectomy are contained in the database of this multinational study. Of the patients 259 were diagnosed with chRCC (4.2 %) and thus formed the study group for this retrospective investigation. These subjects were compared to 4,994 patients with a clear cell subtype (80.1 %) with respect to clinical and histopathological criteria. The independent influence of the chromophobe subtype regarding tumor-specific survival and overall survival was determined using analysis by Cox proportional hazards regression models. The median follow-up was 59 months (interquartile range 29-106 months).

Results

The chRCC patients were significantly younger (60 vs. 63.2 years, p < 0.001), more often female (50 vs. 41 %, p = 0.005) and showed simultaneous distant metastases to a lesser extent (3.5 vs. 7.1 %, p = 0.023) compared to patients with a clear cell subtype. Despite a comparable median tumor size a ≥ pT3 tumor stage was diagnosed in only 24.7 % of the patients compared to of 30.5 % in patients with a clear cell subtype (p = 0.047). In addition to the clinical criteria of age, sex and distant metastases, the histological variables pTN stage, grade and tumor size showed a significant influence on tumor-specific and overall survival. However, in the multivariable Cox regression analysis no independent effect on tumor-specific mortality (HR 0.88, p = 0.515) and overall mortality (HR 1.00, p = 0.998) due to the histological subtype was found (c-index 0.86 and 0.77, respectively).

Conclusions

Patients with chRCC and clear cell RCC differ significantly concerning the distribution of clinical and histopathological criteria. Patients with chRCC present with less advanced tumors which leads to better tumor-specific survival rates in general; however, this advantage could not be verified after adjustment for the established risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Ljungberg B, Cowan NC, Hanbury DC et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406

    Article  PubMed  Google Scholar 

  2. Meskawi M, Sun M, Trinh QD et al (2012) A review of integrated staging systems for renal cell carcinoma. Eur Urol 62(2):303–314

    Article  PubMed  Google Scholar 

  3. Karakiewicz PI, Suardi N, Capitanio U et al (2009) Conditional survival predictions after nephrectomy for renal cell carcinoma. J Urol 182(6):2607–2612

    Article  PubMed  Google Scholar 

  4. Kovacs G, Akhtar M, Beckwith BJ et al (1997) The Heidelberg classification of renal cell tumours. J Pathol 183(2):131–133

    Article  CAS  PubMed  Google Scholar 

  5. Thoenes W, Störkel S, Rumpelt HJ (1985) Human chromophobe cell renal carcinoma. Virchows Arch B Cell Pathol Incl Mol Pathol 48(3):207–217

    Article  CAS  PubMed  Google Scholar 

  6. Bannasch P, Schacht H, Storch E (1974) Morphogenese und Mikromorphologie epithelialer Nierentumoren bei nitrosomorpholin-vergifteten Ratten. Induktion und Histologie der Tumoren. Z Krebsforsch 81:311–331

    Article  CAS  Google Scholar 

  7. Thoenes W, Störkel S, Rumpelt HJ et al (1988) Chromophobe cell renal carcinoma and its variants – a report on 32 cases. J Pathol 155(4):277–287

    Article  CAS  PubMed  Google Scholar 

  8. Crotty TB, Farrow GM, Lieber MM (1995) Chromophobe cell renal carcinoma: clinicopathological features of 50 cases. J Urol 154(3):964–967

    Article  CAS  PubMed  Google Scholar 

  9. Akhtar M, Kardar H, Linjawi T et al (1995) Chromophobe cell carcinoma of the kidney. A clinicopathologic study of 21 cases. Am J Surg Pathol 19(11):1245–1256

    Article  CAS  PubMed  Google Scholar 

  10. Renshaw AA, Henske EP, Loughlin KR et al (1996) Aggressive variants of chromophobe renal cell carcinoma. Cancer 78(8):1756–1761

    Article  CAS  PubMed  Google Scholar 

  11. Moch H, Gasser T, Amin MB et al (2000) Prognostic utility of the recently recommended histologic classification and revised TNM staging system of renal cell carcinoma: a Swiss experience with 588 tumors. Cancer 89(3):604–614

    Article  CAS  PubMed  Google Scholar 

  12. Cheville JC, Lohse CM, Zincke H et al (2003) Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma. Am J Surg Pathol 27(5):612–624

    Article  PubMed  Google Scholar 

  13. Beck SD, Patel MI, Snyder ME et al (2004) Effect of papillary and chromophobe cell type on disease-free survival after nephrectomy for renal cell carcinoma. Ann Surg Oncol 11(1):71–77

    Article  PubMed  Google Scholar 

  14. Peyromaure M, Misrai V, Thiounn N et al (2004) Chromophobe renal cell carcinoma: analysis of 61 cases. Cancer 100(7):1406–1410

    Article  PubMed  Google Scholar 

  15. Cindolo L, Taille A de la, Schips L et al (2005) Chromophobe renal cell carcinoma: comprehensive analysis of 104 cases from multicenter European database. Urology 65(4):681–686

    Article  PubMed  Google Scholar 

  16. Patard JJ, Leray E, Rioux-Leclercq N et al (2005) Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol 23(12):2763–2771

    Article  PubMed  Google Scholar 

  17. Delahunt B, Sika-Paotonu D, Bethwaite PB et al (2007) Fuhrman grading is not appropriate for chromophobe renal cell carcinoma. Am J Surg Pathol 31(6):957–960

    Article  PubMed  Google Scholar 

  18. Zini L, Leroy X, Lemaitre L et al (2008) Tumour necrosis in chromophobe renal cell carcinoma: clinical data to distinguish aggressive variants. Eur J Surg Oncol 34(6):687–691

    Article  CAS  PubMed  Google Scholar 

  19. Klatte T, Han KR, Said JW et al (2008) Pathobiology and prognosis of chromophobe renal cell carcinoma. Urol Oncol 26(6):604–609

    Article  PubMed  Google Scholar 

  20. Amin MB, Paner GP, Alvarado-Cabrero I et al (2008) Chromophobe renal cell carcinoma: histomorphologic characteristics and evaluation of conventional pathologic prognostic parameters in 145 cases. Am J Surg Pathol 32(12):1822–1834

    Article  PubMed  Google Scholar 

  21. Paner GP, Amin MB, Alvarado-Cabrero I et al (2010) A novel tumor grading scheme for chromophobe renal cell carcinoma: prognostic utility and comparison with Fuhrman nuclear grade. Am J Surg Pathol 34(9):1233–1240

    Article  PubMed  Google Scholar 

  22. Crépel M, Isbarn H, Capitanio U et al (2009) Does histologic subtype affect oncologic outcomes after nephron-sparing surgery? Urology 74(4):842–845

    Article  PubMed  Google Scholar 

  23. Capitanio U, Cloutier V, Zini L et al (2009) A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study. BJU Int 103(11):1496–1500

    Article  PubMed  Google Scholar 

  24. Volpe A, Novara G, Antonelli A et al (2012) Chromophobe renal cell carcinoma (RCC): oncological outcomes and prognostic factors in a large multicentre series. BJU Int 110(1):76–83

    Article  PubMed  Google Scholar 

  25. Cheville JC, Lohse CM, Sukov WR et al (2012) Chromophobe renal cell carcinoma: the impact of tumor grade on outcome. Am J Surg Pathol 36(6):851–856

    Article  PubMed  Google Scholar 

  26. Zhao PJ, Chen XP, Li XS et al (2012) Chromophobe renal cell carcinoma: analysis of 53 cases. J Cancer Res Clin Oncol 138(3):451–454

    Article  PubMed  Google Scholar 

  27. Greene FL, Gospodarowicz M, Wittekend C et al (2009) American Joint Committee on Cancer (AJCC) staging manual, 7th edn. Springer, Berlin Heidelberg New York

  28. Fuhrman S, Lasky LC, Limas L (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663

    Article  CAS  PubMed  Google Scholar 

  29. Harrell FE Jr, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387

    Article  PubMed  Google Scholar 

  30. Casuscelli J, Gratzke C, Stief CG, Staehler M (2012) Partial nephrectomy. Rationale and limitations of an organ-preserving approach. Urologe A 51(9):1194–1201

    Article  CAS  PubMed  Google Scholar 

Download references

Einhaltung der ethischen Richtlinien

Interessenkonflikt. M. May, R. Zigeuner, A. Aziz, L. Cindolo, C. Gilfrich, L. Schips, O. De Cobelli, B. Rocco, C. De Nunzio, A. Tubaro, I. Coman, B. Feciche, M. Truss, B. Hoschke, O. Dalpiaz, A. Stoltze, F. Fenske, H.-M. Fritsche, T. Chromecki, S. Lebentrau, R.S. Figenshau, K. Madison, M. Sánchez-Chapado, M. del Carmen Santiago Martin, L. Salzano, G. Lotrecchiano, S. Joniau, R. Waidelich, C.G. Stief und S. Brookman-May geben an, dass kein Interessenkonflikt besteht. Alle angewandten Verfahren stehen im Einklang mit den ethischen Normen der verantwortlichen Kommission für Forschung am Menschen (institutionell und national) und mit der Deklaration von Helsinki von 1975 in der revidierten Fassung von 2008. Alle Patienten wurden erst nach erfolgter Aufklärung und Einwilligung in die Studie eingeschlossen. Soweit der Beitrag personenbezogene Daten enthält, wurde von den Patienten eine zusätzliche Einwilligung nach erfolgter Aufklärung eingeholt. Sämtliche institutionellen und nationalen Richtlinien zur Haltung und zum Einsatz von Labortieren wurden befolgt. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik für Urologie, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Straße 23, 94315, Straubing, Deutschland

    M. May & C. Gilfrich

  2. Urologische Klinik, Medizinische Universität zu Graz, Graz, Österreich

    R. Zigeuner, O. Dalpiaz & T. Chromecki

  3. Caritas-Krankenhaus St. Josef, Urologische Klinik, Universität zu Regensburg, Regensburg, Deutschland

    A. Aziz, A. Stoltze, F. Fenske & H.-M. Fritsche

  4. Department of Urology, Pio Da Pietrelcina Hospital, Vasto, Italien

    L. Cindolo & L. Schips

  5. Division of Urology, European Institute of Oncology, Milano, Italien

    O. De Cobelli

  6. Department of Urology, Università degli Studi di Milano, Fondazione IRCCS Ca‘ Granda, Ospedale Maggiore Policlinico, Milano, Italien

    B. Rocco

  7. Faculty of Health Sciences, Department of Urology, University „La Sapienza“, Ospedale Sant’Andrea, Rome, Italien

    C. De Nunzio & A. Tubaro

  8. Department of Urology, Clinical Municipal Hospital, Cluj-Napoca, Rumänien

    I. Coman & B. Feciche

  9. Urologische Klinik, Klinikum Dortmund, Dortmund, Deutschland

    M. Truss

  10. Urologische Klinik, Carl-Thiem-Klinikum Cottbus, Cottbus, Deutschland

    B. Hoschke

  11. Klinik für Urologie, Ruppiner Kliniken Neuruppin, Neuruppin, Deutschland

    S. Lebentrau

  12. Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Washington, USA

    R.S. Figenshau & K. Madison

  13. Department of Urology, Hospital Universitario Principe de Asturias, Alcala de Henares, Madrid, Spainien

    M. Sánchez-Chapado & M. del Carmen Santiago Martin

  14. Department of Urology, G. Rummo Hospital, Benevento, Italien

    L. Salzano & G. Lotrecchiano

  15. University of Leuven, Leuven, Belgien

    S. Joniau

  16. Urologische Klinik, LMU München, München, Deutschland

    R. Waidelich, C.G. Stief & S. Brookman-May

Authors
  1. M. May
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Zigeuner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Aziz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Cindolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Gilfrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Schips
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. O. De Cobelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. B. Rocco
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. De Nunzio
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A. Tubaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. I. Coman
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. B. Feciche
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M. Truss
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. B. Hoschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. O. Dalpiaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. A. Stoltze
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. F. Fenske
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. H.-M. Fritsche
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. T. Chromecki
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. S. Lebentrau
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. R.S. Figenshau
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. K. Madison
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. M. Sánchez-Chapado
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. M. del Carmen Santiago Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. L. Salzano
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. G. Lotrecchiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. S. Joniau
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. R. Waidelich
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. C.G. Stief
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. S. Brookman-May
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Mitglieder des „CORONA projects“ und/oder der Projektgruppe „Young Academic Urologists Renal Cancer Group“ der European Association of Urology (EAU)

Corresponding author

Correspondence to M. May.

Additional information

M. May und R. Zigeuner waren zu gleichen Teilen an der Manuskripterstellung beteiligt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

May, M., Zigeuner, R., Aziz, A. et al. Die postoperative Prognose des chromophoben Nierenzellkarzinoms. Urologe 53, 228–235 (2014). https://doi.org/10.1007/s00120-013-3237-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-013-3237-y

Schlüsselwörter

Keywords

Search

Navigation