2002 NON-CLEAR CELL HISTOLOGY IS INDEPENDENTLY ASSOCIATED WITH POOR OUTCOMES IN THE TARGETED THERAPY ERA (2012)

You have accessJournal of UrologyKidney Cancer: Advanced II1 Apr 20122002 NON-CLEAR CELL HISTOLOGY IS INDEPENDENTLY ASSOCIATED WITH POOR OUTCOMES IN THE TARGETED THERAPY ERA Edward N. Rampersaud, Frederic D. Birkhauser, Joshua E. Logan, Geoffrey Sonn, Yvonne Chan, Frederic Pouliot, Xiaoyan Wang, Gang Li, Fairooz Kabbinavar, Allan J. Pantuck, and Arie S. Belldegrun Edward N. RampersaudEdward N. Rampersaud Los Angeles, CA More articles by this author , Frederic D. BirkhauserFrederic D. Birkhauser Los Angeles, CA More articles by this author , Joshua E. LoganJoshua E. Logan Los Angeles, CA More articles by this author , Geoffrey SonnGeoffrey Sonn Los Angeles, CA More articles by this author , Yvonne ChanYvonne Chan Los Angeles, CA More articles by this author , Frederic PouliotFrederic Pouliot Los Angeles, CA More articles by this author , Xiaoyan WangXiaoyan Wang Los Angeles, CA More articles by this author , Gang LiGang Li Los Angeles, CA More articles by this author , Fairooz KabbinavarFairooz Kabbinavar Los Angeles, CA More articles by this author , Allan J. PantuckAllan J. Pantuck Los Angeles, CA More articles by this author , and Arie S. BelldegrunArie S. Belldegrun Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2164AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The role of targeted therapy (TT) in metastatic renal cell carcinoma (mRCC) having non-clear cell histology (non-ccRCC) is still being defined. We sought to examine the factors associated with survival outcomes in patients presenting with these histological subtypes in the TT era at a dedicated, large-volume kidney cancer program. METHODS The UCLA Kidney Cancer Program database containing records of over 2500 patients was queried. The clinicopathologic factors between patients with clear cell subtype (ccRCC) and those with non-clear cell histology were compared using the Student's T-test and the chi-square test for continuous and categorical variables, where appropriate. Survival outcomes were estimated using Kaplan-Meier (log rank). Univariate and multivariate Cox regression models were used to identify independent associations with survival. RESULTS Of 157 patients treated with FDA-approved TT, 132 (84%) had ccRCC while 25 (16%) had non-ccRCC. The two groups were balanced for baseline demographic variables, including age, gender, race, BMI, pack-years of smoking, T-stage, Fuhrman grade, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and UCLA Integrated Staging System (UISS) risk category. Median survival of patients with ccRCC and non-ccRCC was 41.6 and 18.1 months (p<0.001). In multivariate analysis, non-ccRCC was associated with a 2.49-fold risk of cancer specific death compared to ccRCC patients. Among patients receiving TT-only, median survival of patients with ccRCC and non-ccRCC was 35.0 and 15.4 months (p=0.007). A subset of ccRCC patients treated sequentially with IMT followed by TT had a median survival of 73 months. Worsening UISS risk class and non-ccRCC histology, but not age, gender, race, tobacco exposure history, or tumor size, were independently associated with the risk of cancer death. CONCLUSIONS Even after controlling for UISS risk category, non-clear cell histology emerges as the most significant independent risk factor for cancer specific death for mRCC patients treated by TT. Furthermore, subset analysis among those with clear cell histology suggests that carefully selected patients may achieve outstanding survival when treated by upfront immunotherapy followed by salvage TT upon progression. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e807-e808 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edward N. Rampersaud Los Angeles, CA More articles by this author Frederic D. Birkhauser Los Angeles, CA More articles by this author Joshua E. Logan Los Angeles, CA More articles by this author Geoffrey Sonn Los Angeles, CA More articles by this author Yvonne Chan Los Angeles, CA More articles by this author Frederic Pouliot Los Angeles, CA More articles by this author Xiaoyan Wang Los Angeles, CA More articles by this author Gang Li Los Angeles, CA More articles by this author Fairooz Kabbinavar Los Angeles, CA More articles by this author Allan J. Pantuck Los Angeles, CA More articles by this author Arie S. Belldegrun Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...