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Assessment of tumour‐associated necrosis provides prognostic information additional to World Health Organization/International Society of Urological Pathology grading for clear cell renal cell carcinoma
Author(s) -
Dagher Julien,
Delahunt Brett,
RiouxLeclercq Nathalie,
Egevad Lars,
Coughlin Geoff,
Dunglison Nigel,
Gianduzzo Troy,
Kua Boon,
Malone Greg,
Martin Ben,
Preston John,
Pokorny Morgan,
Wood Simon,
Samaratunga Hemamali
Publication year - 2019
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13737
Subject(s) - medicine , grading (engineering) , renal cell carcinoma , nephrectomy , multivariate analysis , clear cell , clear cell renal cell carcinoma , carcinoma , cancer staging , metastasis , univariate analysis , pathological , pathology , cancer , oncology , kidney , civil engineering , engineering
Aims The aims of this study were to evaluate the impact of tumour‐associated necrosis ( TAN ) on metastasis‐free survival for clear cell renal cell carcinoma ( RCC ), and to determine whether TAN provides survival information additional to World Health Organization ( WHO )/International Society of Urological Pathology ( ISUP ) grading. Methods and results The study consisted of 376 cases of clear cell RCC treated by nephrectomy, for which follow‐up was available. WHO / ISUP grade was assigned, and sections were assessed for the presence of TAN . American Joint Committee on Cancer ( AJCC ) pT staging category and tumour size were also recorded. The development of metastatic disease was taken as the clinical endpoint, and survival analyses, utilising univariate and multivariate models, were performed. WHO / ISUP grades were: grade 1, 35 cases (9.3%); grade 2, 188 cases (50.0%); grade 3, 91 cases (24.2%); and grade 4, 62 cases (16.5%). Staging categories were pT 1– pT 2 [234 tumours (62.2%)] and pT 3– pT 4 [139 tumours (37.0%)]. TAN was seen in 128 cases (34.0%). Neither TAN nor metastases were seen in grade 1 tumours. Among grade 2–4 tumours, those with TAN had a significantly worse prognosis than those without TAN ( P = 0.017, P = 0.04, and P = 0.006, respectively). Multivariate analysis ( WHO / ISUP grade, pT staging category, and TAN ) showed all three variables to be independently associated with outcome ( P = 0.009, P = 0.005, and P = 0.001, respectively). For all tumour grades and pT staging categories, it was found that the presence of TAN was associated with a 2.91‐fold greater risk of metastatic disease. Conclusion Tumour‐associated necrosis is an important prognostic factor for clear cell RCC , independently of WHO / ISUP grade. This supports the suggestion that TAN could be incorporated into tumour grading criteria.