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Published on: January 22, 2013
Does WHO/ISUP grade IV histology provide prognostic insight in chromophobe renal cell carcinoma?
Serdar Turan1, Selcuk Erdem2, Selman Mert1
1Department of Urology, Taksim Training and Research Hospital, Istanbul, Turkey.
Objective:
Chromophobe renal cell carcinoma (chRCC) is generally considered a less aggressive renal malignancy, yet a clinically meaningful subset displays adverse outcomes. We evaluated the prognostic impact of WHO/ISUP Grade IV histology on cancer-specific survival (CSS) in a large population-based, propensity score-matched cohort.
Methods:
The SEER database (2000-2021) was queried for patients with chRCC. Patients were stratified according to WHO/ISUP grade into Grade IV chRCC and Grade I-III chRCC. The primary endpoint was CSS. A 2:1 nearest-neighbor PSM was performed using age, sex, race, AJCC stage, and tumor size. Fine-Gray competing-risk regression was performed in both the overall and propensity score-matched cohorts.
Results:
A total of 6243 patients with chRCC were identified, including 394 (6.3%) with Grade IV histology. In the overall cohort, Grade IV chRCC was independently associated with worse CSS (HR 2.38, 95%CI 1.78-3.18, p < 0.001). After PSM (n = 1107), this association persisted (HR 1.96, 95%CI 1.43-2.69, p < 0.001) and was supported by competing-risk analysis in both the overall cohort (sHR 2.07, 95% CI 1.53-2.79, p < 0.001) and the matched cohort (sHR 1.80, 95%CI 1.32-2.46, p < 0.001).
Conclusion:
In this large, propensity score-matched, population-based cohort, WHO/ISUP Grade IV chRCC was independently associated with poorer CSS, even after adjustment for tumor burden and stage. These findings should be interpreted within the limitations of registry-defined Grade IV classification.
