Presence of Tumor Necrosis is Not a Significant Predictor of Survival in Clear Cell Renal Cell Carcinoma: Higher Prognostic Accuracy of Extent Based Rather Than Presence/Absence Classification

Tobias Klatte, Jonathan W. Said, Michela de Martino, Jeffrey LaRochelle, Brian Shuch, Jian Yu Rao, George Thomas, Fairooz F. Kabbinavar, Arie S. Belldegrun, Allan J. Pantuck

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Purpose: The presence of necrosis has been proposed as an adverse prognostic factor in clear cell renal cell carcinoma. However, classification based on a presence/absence basis ignores its heterogeneity, which may be associated with other important pathological factors and prognosis. We performed the first prospective study of necrosis in clear cell renal cell carcinoma to our knowledge and tested the traditional presence/absence classification vs an alternative extent based classification. Materials and Methods: We studied the presence and extent of tumor necrosis, pathological features and cancer specific survival of 343 consecutive patients. Results: Tumor necrosis was present in 227 tumors (66%) and was associated with more advanced tumors. However, the predictive accuracy for cancer specific survival was low (64.6%) and the presence of necrosis was not retained as an independent prognostic factor on multivariate analysis (p = 0.299). There was significant heterogeneity among tumors with necrosis. Increasing extent of necrosis was associated with poorer performance status, higher T, N, M stages and grades, vascular invasion and sarcomatoid features. Extent based classification predicted cancer specific survival better than presence alone (74.5% vs 64.6%) and was retained as an independent prognostic factor on multivariate analysis (p = 0.029). For clinical use a cutoff of 20% was identified for further prognostic subclassification of tumors with necrosis (c-index 71.7%). Conclusions: Tumor necrosis is an adverse prognostic factor in clear cell renal cell carcinoma but prospective evaluation of necrosis on a presence/absence basis shows that it does not provide independent prognostic information. The predictive accuracy of an extent based classification is superior and is retained as an independent prognostic factor. We recommend the scoring of necrosis according to its extent with further subclassification based on a 20% cutoff.

Original languageEnglish (US)
Pages (from-to)1558-1564
Number of pages7
JournalJournal of Urology
Volume181
Issue number4
DOIs
StatePublished - Apr 2009
Externally publishedYes

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Renal Cell Carcinoma
Necrosis
Survival
Neoplasms
Multivariate Analysis
Blood Vessels
Prospective Studies

Keywords

  • carcinoma
  • kidney neoplasms
  • necrosis
  • renal cell
  • survival

ASJC Scopus subject areas

  • Urology

Cite this

Presence of Tumor Necrosis is Not a Significant Predictor of Survival in Clear Cell Renal Cell Carcinoma : Higher Prognostic Accuracy of Extent Based Rather Than Presence/Absence Classification. / Klatte, Tobias; Said, Jonathan W.; de Martino, Michela; LaRochelle, Jeffrey; Shuch, Brian; Rao, Jian Yu; Thomas, George; Kabbinavar, Fairooz F.; Belldegrun, Arie S.; Pantuck, Allan J.

In: Journal of Urology, Vol. 181, No. 4, 04.2009, p. 1558-1564.

Research output: Contribution to journalArticle

Klatte, Tobias ; Said, Jonathan W. ; de Martino, Michela ; LaRochelle, Jeffrey ; Shuch, Brian ; Rao, Jian Yu ; Thomas, George ; Kabbinavar, Fairooz F. ; Belldegrun, Arie S. ; Pantuck, Allan J. / Presence of Tumor Necrosis is Not a Significant Predictor of Survival in Clear Cell Renal Cell Carcinoma : Higher Prognostic Accuracy of Extent Based Rather Than Presence/Absence Classification. In: Journal of Urology. 2009 ; Vol. 181, No. 4. pp. 1558-1564.
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abstract = "Purpose: The presence of necrosis has been proposed as an adverse prognostic factor in clear cell renal cell carcinoma. However, classification based on a presence/absence basis ignores its heterogeneity, which may be associated with other important pathological factors and prognosis. We performed the first prospective study of necrosis in clear cell renal cell carcinoma to our knowledge and tested the traditional presence/absence classification vs an alternative extent based classification. Materials and Methods: We studied the presence and extent of tumor necrosis, pathological features and cancer specific survival of 343 consecutive patients. Results: Tumor necrosis was present in 227 tumors (66{\%}) and was associated with more advanced tumors. However, the predictive accuracy for cancer specific survival was low (64.6{\%}) and the presence of necrosis was not retained as an independent prognostic factor on multivariate analysis (p = 0.299). There was significant heterogeneity among tumors with necrosis. Increasing extent of necrosis was associated with poorer performance status, higher T, N, M stages and grades, vascular invasion and sarcomatoid features. Extent based classification predicted cancer specific survival better than presence alone (74.5{\%} vs 64.6{\%}) and was retained as an independent prognostic factor on multivariate analysis (p = 0.029). For clinical use a cutoff of 20{\%} was identified for further prognostic subclassification of tumors with necrosis (c-index 71.7{\%}). Conclusions: Tumor necrosis is an adverse prognostic factor in clear cell renal cell carcinoma but prospective evaluation of necrosis on a presence/absence basis shows that it does not provide independent prognostic information. The predictive accuracy of an extent based classification is superior and is retained as an independent prognostic factor. We recommend the scoring of necrosis according to its extent with further subclassification based on a 20{\%} cutoff.",
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T1 - Presence of Tumor Necrosis is Not a Significant Predictor of Survival in Clear Cell Renal Cell Carcinoma

T2 - Higher Prognostic Accuracy of Extent Based Rather Than Presence/Absence Classification

AU - Klatte, Tobias

AU - Said, Jonathan W.

AU - de Martino, Michela

AU - LaRochelle, Jeffrey

AU - Shuch, Brian

AU - Rao, Jian Yu

AU - Thomas, George

AU - Kabbinavar, Fairooz F.

AU - Belldegrun, Arie S.

AU - Pantuck, Allan J.

PY - 2009/4

Y1 - 2009/4

N2 - Purpose: The presence of necrosis has been proposed as an adverse prognostic factor in clear cell renal cell carcinoma. However, classification based on a presence/absence basis ignores its heterogeneity, which may be associated with other important pathological factors and prognosis. We performed the first prospective study of necrosis in clear cell renal cell carcinoma to our knowledge and tested the traditional presence/absence classification vs an alternative extent based classification. Materials and Methods: We studied the presence and extent of tumor necrosis, pathological features and cancer specific survival of 343 consecutive patients. Results: Tumor necrosis was present in 227 tumors (66%) and was associated with more advanced tumors. However, the predictive accuracy for cancer specific survival was low (64.6%) and the presence of necrosis was not retained as an independent prognostic factor on multivariate analysis (p = 0.299). There was significant heterogeneity among tumors with necrosis. Increasing extent of necrosis was associated with poorer performance status, higher T, N, M stages and grades, vascular invasion and sarcomatoid features. Extent based classification predicted cancer specific survival better than presence alone (74.5% vs 64.6%) and was retained as an independent prognostic factor on multivariate analysis (p = 0.029). For clinical use a cutoff of 20% was identified for further prognostic subclassification of tumors with necrosis (c-index 71.7%). Conclusions: Tumor necrosis is an adverse prognostic factor in clear cell renal cell carcinoma but prospective evaluation of necrosis on a presence/absence basis shows that it does not provide independent prognostic information. The predictive accuracy of an extent based classification is superior and is retained as an independent prognostic factor. We recommend the scoring of necrosis according to its extent with further subclassification based on a 20% cutoff.

AB - Purpose: The presence of necrosis has been proposed as an adverse prognostic factor in clear cell renal cell carcinoma. However, classification based on a presence/absence basis ignores its heterogeneity, which may be associated with other important pathological factors and prognosis. We performed the first prospective study of necrosis in clear cell renal cell carcinoma to our knowledge and tested the traditional presence/absence classification vs an alternative extent based classification. Materials and Methods: We studied the presence and extent of tumor necrosis, pathological features and cancer specific survival of 343 consecutive patients. Results: Tumor necrosis was present in 227 tumors (66%) and was associated with more advanced tumors. However, the predictive accuracy for cancer specific survival was low (64.6%) and the presence of necrosis was not retained as an independent prognostic factor on multivariate analysis (p = 0.299). There was significant heterogeneity among tumors with necrosis. Increasing extent of necrosis was associated with poorer performance status, higher T, N, M stages and grades, vascular invasion and sarcomatoid features. Extent based classification predicted cancer specific survival better than presence alone (74.5% vs 64.6%) and was retained as an independent prognostic factor on multivariate analysis (p = 0.029). For clinical use a cutoff of 20% was identified for further prognostic subclassification of tumors with necrosis (c-index 71.7%). Conclusions: Tumor necrosis is an adverse prognostic factor in clear cell renal cell carcinoma but prospective evaluation of necrosis on a presence/absence basis shows that it does not provide independent prognostic information. The predictive accuracy of an extent based classification is superior and is retained as an independent prognostic factor. We recommend the scoring of necrosis according to its extent with further subclassification based on a 20% cutoff.

KW - carcinoma

KW - kidney neoplasms

KW - necrosis

KW - renal cell

KW - survival

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