Renal cell carcinoma (RCC) is the third most common genitourinary cancer in the world, and has the highest mortality rates among these types of cancers. In the present cross-sectional assessment, the prevalence of RCC subtypes in a sample of Iranian patients diagnosed with RCC which have undergone nephrectomy surgery between years 2014 to 2019 in a referral medical center has been investigated. We have studied 68 patients, including 47 male and 21 female individuals with an average age of 55. The patients have been studied for demographic and pathologic information such as age, sex, tumor size, tumor subtype, TNM staging, Fuhrman nuclear grading, and other pathological information. The statistical analysis was done via SPSS software version 21. Quantitative data were examined by T test and qualitative data were assessed by Chi square test. As we observed in the results, the most common RCC subtype among these patients was clear cell 53%, followed by papillary 22% and chromophobe 19%, emphasizing the higher rates of chromophobe RCC compared to the statistics worldwide

Allameh, Farzad

Mohajer, Zahra

Moradi, Afshin

English

Journals Portal, Shahid Beheshti University of Medical Sciences

Men’s Health Journal. 2021; 5(1): e10ORIGINAL RESEARCHPrevalence of Different Subtypes of Renal Cell Carci-noma among Patients who have Undergone Nephrectomy;Statistics of a Referral Medical Center in IranZahra Mohajer1, Afshin Moradi2, Farzad Allameh3∗1. MD; Shahid Beheshti University of Medical Sciences, Tehran, Iran.2. MD Professor of Pathology; Department of Pathology, Shohadae-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran,Iran.3. MD-MPH Assistant Professor of Urology; Men’s Health & Reproductive Health Research Center, Shahid Beheshti University of MedicalSciences, Tehran, Iran.Received: January 2021; Accepted: January 2021; Published online: February 2021Abstract: Renal cell carcinoma (RCC) is the third most common genitourinary cancer in the world, and has the high-est mortality rates among these types of cancers. In the present cross-sectional assessment, the prevalence ofRCC subtypes in a sample of Iranian patients diagnosed with RCC which have undergone nephrectomy surgerybetween years 2014 to 2019 in a referral medical center has been investigated. We have studied 68 patients,including 47 male and 21 female individuals with an average age of 55. The patients have been studied for de-mographic and pathologic information such as age, sex, tumor size, tumor subtype, TNM staging, Fuhrmannuclear grading, and other pathological information. The statistical analysis was done via SPSS software ver-sion 21. Quantitative data were examined by T test and qualitative data were assessed by Chi square test. Aswe observed in the results, the most common RCC subtype among these patients was clear cell 53%, followedby papillary 22% and chromophobe 19%, emphasizing the higher rates of chromophobe RCC compared to thestatistics worldwide.Keywords: Renal Cell Carcinoma; Nephrectomy; Pathology; Chromophobe Renal Cell Carcinoma; Clear Cell Renal CellCarcinoma; Prevalence; HistologyCite this article as: Mohajer Z, Moradi A, Allameh F. Prevalence of Different Subtypes of Renal Cell Carcinoma among Patients who haveUndergone Nephrectomy; Statistics of a Referral Medical Center in Iran. Mens Health J. 2021; 5(1): e10.1. IntroductionThe most common cancer of the kidney is renal cell carci-noma. It consists of different histologic subtypes (1, 2). RCChas the highest mortality rates among all genitourinary can-cers. It also ranks the third most common genitourinary can-cer worldwide (3). If diagnosed in the early stages, this cancercan be easily controlled by performing nephrectomy surgery.Nevertheless, a low percentage of patients still remain at riskof tumor recurrence (4). In addition, in patients with metas-tasis (mRCC), it is usually considered as an incurable disease.All RCC subtypes are different in prognosis and recurrence∗Corresponding Author: Farzad Allameh; Address: Department of Urology,Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: farzadal-lameh@sbmu.ac.ir, Tel: (+98)9123885545.rates. According to a study performed on 290 patients byZhou H et al, results have shown that patients with clear cell-papillary RCC have been diagnosed in early stages when thetumor size is rather smaller. In addition, this particular sub-type of RCC has not led to metastasis or cancer-specific deathin any of the patients (5).In another investigation on 840 patients by Lau WK et al, asignificant difference in cancer-specific survival (CSS) andmetastasis-free survival (MFS) rates among different RCCsubtypes was observed. According to this research CSS andMFS for clear cell RCC are 89.1% and 88.6% respectively, forpapillary RCC they are 95% and 93.8%, and for ChromophobeRCC they are both 100%. This study proves that prognosis ofthis cancer strongly depend on the RCC subtype (6).The most common subtype of this cancer is clear cell (ccRCC)and it is the mostly fatal subtype of renal cancer (7).According to a study by Lucca I et al, men are more likely toThis open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jmp.iums.ac.irZ. Mohajer et al. 2be diagnosed with renal cell carcinoma than women. Andthey usually have tumors with larger sizes and higher gradeand stage (8).In an assessment, Nicodemus KK et al studied 41,836 women.The results have shown that obesity and central accumula-tion of adipose tissue can be a risk factor for renal cancer inpostmenopausal women (9).Due to the inadequacy of statistics available on this matteramong Iranian population, we attempted to conduct this sur-vey. The current study aims to assess the prevalence of dif-ferent subtypes of RCC in patients undergone nephrectomysurgery in Shohadae-Tajrish hospital during 2014 to 2019.2. Materials and MethodsThis cross-sectional study is conducted on a sample of 68 in-dividuals (47 men and 21 women) with average age of 55 un-dergone nephrectomy surgery in Shohadae-Tajrish hospital.Subjects with clinically proven RCC were comprised the casegroup of the current survey.Demographic and pathologic characteristics were gatheredfrom all the participants. Pathologic characteristics like tu-mor subtype, TNM staging, Fuhrman nuclear grade, tu-mor size, neurolymphovascular invasion, necrosis, reactivelymph nodes, and surgical margins were measured.The statistical analysis was done via SPSS software version21. Quantitative data were examined by T test. Moreover, Chisquare test was applied for qualitative variables.3. ResultsIn this cross-sectional survey, 68 patients with average age of55 were studied. The majority of the participants (approx-imately 69%) were men. 59 patients (87%) had undergoneradical nephrectomy and the other 9 (13%) had undergonepartial nephrectomy. The frequency of Fuhrman grading be-tween men included in this study were as follows: 4 men(13%) presented grade I, 14 men (45%) grade II, 9 men (29%)grade III, and 4 men (13%) presented grade IV. In 21 patientsof this group, (68%) necrosis was present, and in 10 patients(32%) necrosis was not identified. Margins of the resected tis-sue were tumor-free in 31 cases (67%) and in 15 cases (33%)margins were involved by the tumor. In 18 cases (86%) no sar-comatoid or rhabdoid feature were seen, but in 3 cases (14%)at least one of these features were present. Also, in 17 cases(61%) no reactive lymph node were detected in the resectedtissue, in 10 cases (35.7%) only one lymph node, and in 1 man(3.3%) 3 lymph nodes were detected.Women included almost 31% of the participants. Among allthe 21 women studied, majority of them were in the post-menopausal age group. The frequency of Fuhrman gradingbetween women in this survey were as follows: 1 patient(5.6%) presented grade I, 11 patients (61%) grade II, 5 pa-tients (27.8%) grade III, and 1 patient (5.6%) presented gradeIV. In 6 cases of this group (40%) necrosis was present, andin 9 cases (60%) necrosis was not identified. Margins of theresected tissue were tumor-free in 15 cases (75%) and in 5cases (25%) margins were involved by the tumor. In 9 cases(90%) no sarcomatoid or rhabdoid feature were seen, but in 1woman (10%) rhabdoid features were present. Also in 7 cases(77.8%) no reactive lymph node were detected in the resectedtissue, in 1 woman (11.1%) only one lymph node, and in 1woman (11.1%) 2 lymph nodes were detected.Information about 64 patients who have shown clear cell,papillary and chromophobe subtypes are presented in table1. Among the other 4 patients, 2 of them were presented withtranslocation carcinoma. Both were female with the averageage of 20. They both had grade II tumors, with mean size of5.7 cm. In one of them, the margins were tumor-free and inthe other patient, they were involved by tumor. In addition,in one of these patients no lymph node were identified, andin the other one only 1 node was detected.The patient with collecting duct carcinoma was a 57 year-oldman with mean tumor size of 4.5 cm. Necrosis was presentin the tissue resected, and margins were involved by tumor.The last patient was a 38 year-old man with unclassified RCC,with mean tumor size of 16 cm. The tumor was in gradeIV. Necrosis, sarcomatoid features and lymphovascular inva-sions were present. The margins were also involved.In general, 36 patients (53%) have presented the clear cellsubtype, followed by papillary in 15 patients (22%), chromo-phobe in 13 patients (19%), translocation carcinoma in 2 pa-tients (3%), collecting duct carcinoma in 1 patient (1.5%), andunclassified RCC in 1 patient (1.5%). We can see the signifi-cant difference between the frequencies of RCC subtypes inour patients and the universal statistics, especially in chro-mophobe RCC.4. DiscussionTo conclude, this research showed that among these 68patients the most common subtypes are clear cell (53%),followed by papillary (22%) and chromophobe (19%). Al-together 5 patients (10.25%) presented grade I tumor, 25patients (51%) grade II, 14 patients (28.5%) grade III, and 5patients (10.25%) presented grade IV tumor. In 27 patients(58.6%) necrosis was seen. In 46 patients (70%) margins ofthe resected tissue were tumor-free. Neurolymphovascularinvasion was identified in 12 patients (21.4%). Sarcomatoidfeatures were present in 3 patients (9.6%) and rhabdoidfeatures were present in 2 patients (6.4%). Moreover, in 13patients (35%) the tissue contained lymph nodes. We canclearly observe that the male population diagnosed with thiscancer is almost three times as big as the female populationregardless of the RCC subtype.This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jmp.iums.ac.ir3 Men’s Health Journal. 2021; 5(1): e10Table 1: Pathologic characteristics of study patients.Characteristic Clear Cell (n=36) Papillary (n=15) Chromophobe (n=13)Mean age (year) 55 61.3 53.3Sex (M/F) M=25 (69.4%) M=10 (66.7%) M=10 (76.9%)F=11 (30.6%) F=5 (33.3%) F=3 (23.1%)Operation RN=31 (86.1%) RN=12 (80%) RN=12 (92.3%)PN=5 (13.9%) PN=3 (20%) PN=1 (7.7%)Mean tumor Size (cm) 6.5 7.4 10.1Furman Grade G1=5 (14.7%) G1=0 G1=0G2=17 (50%) G2=3 (42.8%) G2=3 (75%)G3=9 (26.5%) G3=3 (42.8%) G3=1 (25%)G4=3 (8.8%) G4=1 (14.4%) G4=0Necrosis Present=10 (43.5%) Present=7 (77.8%) Present=6 (60%)Not seen=13 (56.5%) Not seen=2 (22.2%) Not seen=4 (40%)Margins Tumor free=26 (72.2%) Tumor free=10 (76.9%) Tumor free=9 (69.2%)Involved=10 (27.8%) Involved=3 (23.1%) Involved=4 (30.8%)NLV invasion Present=4 (18.2%) Present=4 (30.8%) Present=2 (20%)Not seen=27 (81.8%) Not seen=9 (69.2%) Not seen=8 (80%)Lymph nodes Present=4 (20%) Present=2 (25%) Present=5 (83.3%)Not seen=16 (80%) Not seen=6 (75%) Not seen=1 (16.7%)M: male; F: female; RN: radical nephrectomy; PN: partial nephrectomy; NLV: Neurolymphovascular invasion.In an investigation on 3062 RCC patients by Leibovich BCthroughout 33 years, the results have shown that clear cellRCC patients comprised 80.5% of all the patients. The per-centage for papillary RCC and chromophobe RCC patientswere 14.3 and 5.2 respectively (10). However, we have foundthat only 53% of our patients were diagnosed with clear cellRCC, 22% with papillary and 19% with chromophobe RCC.The ratio between the different subtypes of this cancer isthe main difference seen in our results. According to a studyconducted by Lipworth L et al on 1549 American patientswith RCC, there was a significant different in distribution ofRCC subtypes among white and black people. In comparisonwith clear cell RCC, there was a higher chance patients withpapillary RCC were black and of male sex. On the contrary,majority of the patients with chromophobe RCC were offemale sex. Overall, clear cell RCC subtype comprised 72.9%among all the tumors. For papillary RCC and chromophobeRCC the percentages were 15.7% and 5% respectively (11,12).In a survey conducted by Wu J et al on 2149 Chinese patientswith clear cell, papillary and chromophobe renal cell carci-noma results show that compared to clear cell RCC patients,there was a higher chance for chromophobe RCC patients tobe female, younger and to have larger tumor size (13).According to this study, chromophobe RCC patients tend tobe younger and have tumors with larger diameters than clearcell and papillary RCC patients; which matches the statisticsthroughout the world. Nevertheless, as we can see in table1 women comprise only 23.1% of the chromophobe RCCpatients; which is another difference we found, compared tothe statistics worldwide.Regarding the fact that RCC does not respond well to neitherradiation therapy nor chemotherapy, there remains mainlytwo modes of treatment: immunotherapy and nephrec-tomy surgery which can be performed as radical or partialnephrectomy (14, 15).Nephron-sparing nephrectomy, also known as partialnephrectomy, can prevent from renal insufficiency andhypertension even in the elderly. It also may cause lowerother-cause mortality rates (16).5. ConclusionWe recommend more extensive research be conducted onthe Iranian population to verify the statistics found in thecurrent study. In addition, on the assumption that the pat-tern of distribution of the RCC subtypes worldwide is differ-ent from Iran, further investigations must be performed.6. Appendix6.1. AcknowledgementsThis research project has been approved by the ethics com-mittee of Shahid Beheshti University of medical sciences.(Ethics code: IR.SBMU.MSP.REC.1396.779)6.2. Author contributionAll the authors have the same contribution.6.3. Funding/SupportNone.This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jmp.iums.ac.irZ. Mohajer et al. 46.4. Conflict of interestAll authors declare that there is no conflict of interest in thisstudy.References1. El Mouallem N, Smith SC, Paul AK, editors. Sarcomatoidrenal cell carcinoma: Biology and treatment advances.Urologic Oncology: Seminars and Original Investigations;2018: Elsevier.2. Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z.2004 WHO classification of the renal tumors of the adults.European urology. 2006;49(5):798-805.3. Russo P, Jang TL, Pettus JA, Huang WC, Eggener SE,O’Brien MF, et al. Survival rates after resection for localizedkidney cancer: 1989 to 2004. Cancer. 2008;113(1):84-96.4. Cairns P. Renal cell carcinoma. Cancer biomarkers.2011;9(1-6):461-73.5. Zhou H, Zheng S, Truong LD, Ro JY, Ayala AG, ShenSS. Clear cell papillary renal cell carcinoma is the fourthmost common histologic type of renal cell carcinoma in290 consecutive nephrectomies for renal cell carcinoma.Human pathology. 2014;45(1):59-64.6. Lau WK, Cheville JC, Blute ML, Weaver AL, Zincke H.Prognostic features of pathologic stage T1 renal cell carci-noma after radical nephrectomy. Urology. 2002;59(4):532-7.7. Vijayalakshmi K, Shankar V, Bain RM, Nolley R, SonnGA, Kao CS, et al. Identification of diagnostic metabolicsignatures in clear cell renal cell carcinoma using massspectrometry imaging. International journal of cancer.2020;147(1):256-65.8. Lucca I, Klatte T, Fajkovic H, De Martino M, ShariatSF. Gender differences in incidence and outcomes ofurothelial and kidney cancer. Nature Reviews Urology.2015;12(10):585.9. Nicodemus KK, Sweeney C, Folsom AR. Evaluation of di-etary, medical and lifestyle risk factors for incident kidneycancer in postmenopausal women. International journalof cancer. 2004;108(1):115-21.10. Leibovich BC, Lohse CM, Crispen PL, Boorjian SA,Thompson RH, Blute ML, et al. Histological subtype is anindependent predictor of outcome for patients with renalcell carcinoma. The Journal of urology. 2010;183(4):1309-16.11. Lipworth L, Morgans AK, Edwards TL, Barocas DA,Chang SS, Herrell SD, et al. Renal cell cancer histologicalsubtype distribution differs by race and sex. BJU interna-tional. 2016;117(2):260-5.12. Qi P, Tsivian M, Abern MR, Passoni NM, McGinleyKF, Polascik TJ, editors. Clinicopathological characteristicsand outcomes of surgically excised renal masses in AfricanAmericans. Urologic Oncology: Seminars and Original In-vestigations; 2014: Elsevier.13. Wu J, Zhang P, Zhang G, Wang H, Gu W, Dai B, et al. Re-nal cell carcinoma histological subtype distribution differsby age, gender, and tumor size in coastal Chinese patients.Oncotarget. 2017;8(42):71797.14. Chin AI, Lam JS, Figlin RA, Belldegrun AS. Surveil-lance strategies for renal cell carcinoma patients followingnephrectomy. Reviews in urology. 2006;8(1):1.15. Lam JS, Belldegrun AS, Figlin RA. Advances inimmune-based therapies of renal cell carcinoma. Expertreview of anticancer therapy. 2004;4(6):1081-96.16. Marchioni M, Preisser F, Bandini M, Nazzani S, TianZ, Kapoor A, et al. Comparison of partial versus radi-cal nephrectomy effect on other-cause mortality, cancer-specific mortality, and 30-day mortality in patients olderthan 75 years. European urology focus. 2019;5(3):467-73.This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).Downloaded from: www.jmp.iums.ac.ir

Prevalence of Different Subtypes of Renal Cell Carcinoma among Patients who have Undergone Nephrectomy; Statistics of a Referral Medical Center in Iran

https://journals.sbmu.ac.ir/mhj/article/download/34251/26701

Prevalence of Different Subtypes of Renal Cell Carcinoma among Patients who have Undergone Nephrectomy; Statistics of a Referral Medical Center in Iran

Abstract

Similar works

Full text

Available Versions

Journals Portal, Shahid Beheshti University of Medical Sciences