Abstract: PD04-01
Sources of Funding: Intramural research program at National Institutes of Health

Introduction

While prognostic factors determining survival in metastatic clear cell renal cell cancer patients are well established, little is known about predictors of outcome in metastatic papillary renal cell cancer (pRCC) patients. We aim to determine the predictors of all-cause mortality (ACM) in pRCC patients.

Methods

Retrospective evaluation of the medical records of patients with metastatic pRCC seen at National Cancer Institute (2000-2014) was undertaken. Patient demographics, tumor characteristics and outcomes were studied. Kaplan-Meier Survival analysis was done to estimate overall survival (OS). Multivariate Cox proportional-hazards regression analysis was done to identify predictors of ACM.

Results

106 consecutive patients with metastatic pRCC were identified. The median age and follow up time after the diagnosis of metastases was 50 years (11-80) and 33.8 mon (2.3-246.7) respectively. Twenty-one (19.8%) and 42 (39.6%) patients had papillary type 1 and papillary type 2 renal cancers respectively; in 43 (40.5%) patients, tumors were classified as papillary, not otherwise specified. Half (53) of patients had hereditary origin of pRCC. Median estimated OS of the entire cohort was 37.5 mon. There was no difference in survival between patients with hereditary or sporadic pRCC (p=0.80) or among patients with different subtypes of pRCC (p=0.79). On univariate analysis, elevated serum corrected calcium, elevated lactate dehydrogenase, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio and presence of malignant ascites significantly affected the patients&[prime] prognosis. Corrected Calcium (p=0.03) and NLR (p=0.004) were found to be independent predictors of ACM on multivariate analysis.

Conclusions

To our knowledge, this is the largest single center series evaluating survival and predictors of ACM within patients with metastatic pRCC. OS was comparable between different subtypes of metastatic pRCC. Elevated NLR and serum corrected calcium are significantly associated with worse OS. Future validation in larger multi-institutional cohorts could justify incorporating corrected calcium and NLR in nomograms predicting ACM in metastatic pRCC.

Funding

Intramural research program at National Institutes of Health