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JU INSIGHT Metastasis Histopathology Impact on Outcomes for Surgically Resected Metastatic Renal Cell Carcinoma
By: Rodrigo Rodrigues Pessoa, MD, Mayo Clinic, Rochester, Minnesota; Reza Nabavizadeh, MD, Mayo Clinic, Rochester, Minnesota; Fernando Quevedo, MD, Mayo Clinic, Rochester, Minnesota; Daniel D. Joyce, MD, Mayo Clinic, Rochester, Minnesota; Christine M. Lohse, MS, Mayo Clinic, Rochester, Minnesota; Vidit Sharma, MD, Mayo Clinic, Rochester, Minnesota; Brian A. Costello, MD, Mayo Clinic, Rochester, Minnesota; Stephen A. Boorjian, MD, Mayo Clinic, Rochester, Minnesota; R. Houston Thompson, MD, Mayo Clinic, Rochester, Minnesota; Bradley C. Leibovich, MD, Mayo Clinic, Rochester, Minnesota; John C. Cheville, MD, Mayo Clinic, Rochester, Minnesota | Posted on: 25 Oct 2023
Pessoa RR, Nabavizadeh R, Quevedo F, et al. The impact of metastasis histopathology on oncologic outcomes for patients with surgically resected metastatic renal cell carcinoma. J Urol. 2023;210(4):611-618.
Study Need and Importance
Current prognostic nomograms for survival among patients with metastatic renal cell carcinoma do not include histopathological features of the metastasis for prediction of oncologic outcomes. In this study, we evaluated the performance of models using primary and metastatic tumor features to predict cancer-specific survival (CSS) among patients with metastatic clear cell renal cell carcinoma who underwent complete metastasectomy.
What We Found
Using our nephrectomy registry, we identified 266 patients who had undergone nephrectomy from 1970 to 2019 for clear cell renal cell carcinoma and complete resection of a single site of metastasis. Relevant clinical and histopathological features readily available to clinicians and with proven association with survival among patients with metastatic renal cell carcinoma were collected. Grade and necrosis from the primary tumor and metastasis were used to calculate 2 versions of the Leibovich score. A third model comprised of anatomical site of the metastasis, timing of metastasectomy in relation to nephrectomy, and grade, necrosis, and sarcomatoid differentiation from the metastasis was also studied. Predictive abilities of these 3 models were compared using c-indexes from Cox proportional hazards models. We demonstrated that both the Leibovich score using grade and necrosis from the metastasis (c=0.679) as well as an additional model with metastatic features only (c=0.707) provided comparable predictive ability for CSS to the originally described score (c=0.675) calculated with primary tumor histopathological features.
Limitations
Our models should only be used for patients with clear cell renal cell carcinoma who have undergone complete metastasectomy, and cannot be extrapolated for use with tissue obtained from biopsy of metastatic sites at this time.
Interpretation for Patient Care
We found that histopathological features of the metastasis can be used to predict CSS for patients with surgically resected metastatic clear cell renal cell carcinoma. Moreover, sarcomatoid features within the metastatic site provide independent prognostic information. Our study argues for investigating whether metastatic biopsy features would prove as useful as resected metastatic specimen data.
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