Özge ERTENER, Sümeyye EKMEKCİ, Ülkü KÜÇÜK

Böbrek Tümörlü Hastalarda Histopatolojik Prognostik Veriler Açısından İleri Yaşın Öneminin Değerlendirilmesi

Böbrek tümörleri erkeklerde daha fazla görülen ve sıklıkla ileri yaş tümörleri kategorisinde yer alan tümörlerdendir. Bu çalışmada histolojik alt tür yanı sıra birçok tanımlanmış histopatolojik prognostik parametrenin bulunduğu böbrek tümörleri için histopatolojik prognostik veriler açısından yaşın öneminin değerlendirilmesi amaçlanmıştır. 2010-2020 yılları arasında nefrektomi uygulanarak böbrek kanseri tanısı almış 75 yaş üzerinde olan 24 hasta çalışmaya dahil edilmiştir. Tümör histolojik alt tipi, tümör derecesi, lenfovasküler invazyon (LVI), perinöral invazyon (PNI), nekroz varlığı, hiler yağ doku ve perirenal yağ doku invazyonu ile cerrahi sınırların durumunu içeren histopatolojik bulguların yaş ile ilişkisi belirlenmiştir. Tümörlerin 23’ü renal hücreli karsinom (RCC), birisi düşük malignite potansiyelli multiloküler kistikrenal hücreli neoplazm olarak sınıflandı. RCC’nin histopatolojik alt tipleri sırasıyla; şeffaf hücreli RCC (n=19), kromofob RCC (n=2), Tip 1 papiller RCC (n=1) ve Tip 2 papiller RCC (n=1) idi. İncelenen histopatolojik veriler arasında renal ven invazyonunun sağkalım açısından istatistiksel anlamlılık gösterdiği saptanmıştır (p=0,002). Ayrıca artan tümör derecesi ile LVI arasında anlamlı ilişki gözlenmiştir (p=0,009). Tümör boyutu, tümör derecesi, nekroz varlığı, lenf nodu metastazı varlığı, perirenal yağ doku invazyonu ve renal ven invazyon varlığı RCC için prognostik belirteçler arasında yer almaktadır. Ancak ileri yaş olgulardan oluşan serimizde; yalnızca renal ven invazyonununun sağkalım açısından prognostik önemli olduğu, diğer tanımlanan belirteçlerin bu yaş gurubunda belirgin etkisinin olmadığı görülmüştür. Bu durum; ileri yaş tümörlerinin diğer yaş gruplarındaki tümörlerden farklılık gösterebileceğine ve rutin kullandığımız verilerin hastaların gidişatını ön görmekte yetersiz kalabileceğine işaret etmektedir.

Anahtar Kelimeler:

Yaşlıların böbrek tümörleri, Renal Hücreli Karsinom, Renal Hücreli Karsinomun Histopatolojik Alt Tipleri, Renal Hücreli Karsinomun Prognostik Parametreleri

Evaluation of the Importance of Advanced Age for Histopathological Prognostic Data in Patients with Kidney Tumor

Kidney tumors are more common in males, and are often considered to be in the category of older-age tumors. In this study, it was aimed to evaluate the importance of age in terms of histopathological prognostic data for kidney tumors, with many defined histopathological prognostic parameters. Twenty–four patients >75 years, who were diagnosed with kidney cancer with nephrectomy between 2010 and 2020, were included in study. The relation between histological features as histological subtype, grade of the tumor, presence of lymphovascular, perineural, hilar and perirenal adipose tissue invasion, necrosis, and the state of surgical margins were determined. Twenty-three tumor samples were classified as renal cell carcinoma (RCC). One sample was classified as multilocular cystic renal cell neoplasm with low malignancy potential. The histopathological subtypes of RCC were; clear cell RCC (n=19), chromophobe RCC (n=2), Type 1 papillary RCC (n=1), and Type 2 papillary RCC (n=1), respectively. Among the histopathological data, renal vein invasion showed statistical significance in terms of survival (p=0.002). In addition, a significant relationship was observed between increasing tumor grade and LVI (p=0.009). Tumor size, and grade, presence of necrosis, lymph node metastasis, perirenal adipose tissue and renal vein invasion are among the prognostic markers for RCC. However, in our series of advanced age cases, only renal vein invasion was found to be prognostic for survival, while other identified markers did not have a significant effect on this age group. This phenomenon indicates that advanced age tumors may differ from tumors in other ages, and the data used routinely may therefore be insufficient to predict the course of the disease.

Keywords:

Renal Cell Carcinoma, Renal Cell Carcinoma, Histopathologic Subtypes Of Renal Cell Carcinoma, Prognostic Parameters Of Renal Cell Carcinoma, Renal Tumors Of Elderly Renal Cell Carcinoma, Histopathologic Subtypes Of Renal Cell Carcinoma, Prognostic Parameters Of Renal Cell Carcinoma, Renal Tumors Of Elderly,

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1. Cinar D, Tas D. Cancer in the elderly. North Clin Istanb. 2015;2(1):73–80.
2. Hsieh JJ, Purdue MP, Signoretti S, et al. Renal cell carcinoma. Nat Rev Dis Primers. 2017;3:17009.
3. Gao X, Hu L, Pan Y, et al. Surgical outcomes of nephrectomy for elderly patients with renal cell carcinoma. Pak J Med Sci. 2018;34(2):288-93.
4. Udager AM, Mehra R. Morphologic, molecular, and taxonomic evolution of renal cell carcinoma: A conceptual perspective with emphasis on updates to the 2016 World Health Organization Classification. Arch Pathol Lab Med. 2016;140(10):1026–37.
5. Wu J, Zhang P, Zhang G, et al. Renal cell carcinoma histological subtype distribution differs by age, gender, and tumor size in coastal Chinese patients. Oncotarget. 2017;8(42):71797-804.
6. Süer E, Baltaci S, Burgu B, et al. Significance of tumor size in renal cell cancer with perinephric fat infiltration: is TNM staging system adequate for predicting prognosis? Urol J. 2013;10(1):774‐9.
7. Moch H, Humphrey PA, Ulbright TM, et al. WHO Classification of Tumours of the Urinary System and Male Genital Organs, 4th edition. Lyon: International Agency for Research on Cancer (IARC), 2016.
8. Amin MB, Paner GP, Alvarado-Cabrero I, et al. Chromophobe renal cell carcinoma: histomorphologic characteristics and evaluation of conventional pathologic prognostic parameters in 145 cases. Am J Surg Pathol. 2008;32(12):1822–34.
9. Przybycin CG, Cronin AM, Darvishian F, et al. Chromophobe renal cell carcinoma: a clinicopathologic study of 203 tumors in 200 patients with primary resection at a single institution. Am J Surg Pathol. 2011;35(7):962–70.
10. Moch H, Cubilla AL, Humphrey PA, et al. WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part A: Renal, Penile and Testicular Tumours. Eur Urol. 2016;70(1):93-105.
11. Teloken PE, Thompson RH, Tickoo SK, et al. Prognostic impact of histological subtype on surgically treated localized renal cell carcinoma. J Urol. 2009;182(5):2132–6.
12. Leibovich BC, Lohse CM, Crispen PL, et al. Histological subtype is an independent predictor of outcome for patients with renal cell carcinoma. J Urol. 2010;183(4):1309–15.
13. Nguyen DP, Vertosick EA, Corradi RB, et al. Histological subtype of renal cell carcinoma significantly impacts survival in the era of partial nephrectomy. Urol Oncol. 2016;34(6):259.e1–8.
14. Özbir S, Canat HL, Atalay HA, et al. Survival Outcomes in Elderly Patients with Renal Cell Carcinoma: A Single-Center Experience, J Reconstr Urol. 2019;9(2):51-6.
15. Panian J, Lin X, Simantov R, et al. The Impact of Age and Gender on Outcomes of Patients with Advanced Renal Cell Carcinoma Treated with Targeted Therapy. Clin Genitourin Cancer. 2020;18(5):e598-609.
16. Gillett MD, Cheville JC, Karnes RJ, et al. Comparison of presentation and outcome for patients 18 to 40 and 60 to 70 years old with solid renal masses. J Urol. 2005;173(6):1893-6.
17. Skolarus TA, Serrano MF, Berger DA, et al. The distribution of histological subtypes of renal tumors by decade of life using the 2004 WHO classification. J Urol. 2008;179(2):439-43.
18. Thompson RH, Hill J, Babayev Y, et al. Risk of metastatic renal cell carcinoma according to tumor size. J Urol. 2009; 182(1):41–5.
19. Vetterlein MW, Jindal T, Becker A, et al. Small renal masses in the elderly: Contemporary treatment approaches and comparative oncological outcomes of nonsurgical and surgical strategies. Investig Clin Urol. 2016;57(4):231-9.
20. Lindskog M, Wahlgren T, Sandin R, et al. Overall survival in Swedish patients with renal cell carcinoma treated in the period 2002 to 2012: Update of the RENCOMP study with subgroup analysis of the synchronous metastatic and elderly populations. Urol Oncol. 2017;35(9):541.e15-22.
21. Cao C, Bi1 X, Liang J, et al. Long-term survival and prognostic factors for locally advanced renal cell carcinoma with renal vein tumor thrombus. BMC Cancer. 2019;19(1):144.
22. Chen X, Li S, Xu Z, et al. Clinical and oncological outcomes in Chinese patients with renal cell carcinoma and venous tumor thrombus extension: single-center experience. World J Surg Oncol. 2015;13:14.
23. Bertini R, Roscigno M, Freschi M, et al. Impact of venous tumour thrombus consistency (solid vs friable) on cancer specific survival in patients with renal cell carcinoma. Eur Urol. 2011;60(2):358–65. 24. Klatte T, Pantuck AJ, Riggs SB, et al. Prognostic factors for renal cell carcinoma with tumor thrombus extension. J Urol. 2007;178(4 Pt 1):1189–95.
25. Abel EJ, Margulis V, Bauman TM, et al. Risk factors for recurrence after surgery in non-metastatic RCC with thrombus: a contemporary multicentre analysis. BJU Int. 2016;117(6B):87– 94.
26. Swami U, Nussenzveig RH, Haaland B, et al. Revisiting AJCC TNM staging for renal cell carcinoma: quest for improvement. Ann Transl Med. 2019;7(1):18.
27. Zhang L, Zha Z, Qu W, et al. Tumor necrosis as a prognostic variable for the clinical outcome in patients with renal cell carcinoma: a systematic review and meta-analysis. BMC Cancer. 2018;18:870.
28. Khor LY, Dhakal HP, Jia X, et al. Tumor necrosis adds prognostically significant information to grade in clear cell renal cell carcinoma a study of 842 consecutive cases from a single institution. Am J Surg Pathol. 2016;40(9):1224-31.
29. Ito K, Seguchi K, Shimazaki H, et al. Tumor necrosis is a strong predictor for recurrence in patients with pathological T1a renal cell carcinoma. Oncol Lett. 2015;9(1):125–30.
30. Delahunt B, McKenney JK, Lohse CM, et al. A novel grading system for clear cell renal cell carcinoma incorporating tumor necrosis. Am J Surg Pathol, 2013;37(3):311-22.
31. Klatte T, Said JW, de Martino M, et al. 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. J Urol. 2009;181(4):1558–64.
32. Signoretti S, Flaifel A, Chen YB, et al. Renal cell carcinoma in the era of precision medicine: from molecular pathology to tissue-based biomarkers. J Clin Oncol. 2018;36(36):3553-9.
33. Voss MH, Reising A, Cheng Y, et al. Genomically annotated risk model for advanced renal-cell carcinoma: a retrospective cohort study. Lancet Oncol 2018;19(12):1688–98.
34. Bi H, Yin J, Zhou L, et al. Clinicopathological and prognostic impact of somatic mutations in Chinese patients with clear cell renal cell carcinoma. Transl Androl Urol. 2020;9(6):2751-63.
35. Volpe A, Patard JJ. Prognostic factors in renal cell carcinoma. World J Urol. 2010;28(3):319–27.