UroToday- Collecting duct carcinoma (CDRCC) is a rare variant of renal cell carcinoma that is usually associated with a poor outcome. Patients frequently present with advanced stage disease that is refractory to conventional systemic therapies and median survival is less than one year. However, patients that present with localized disease, which is extremely rare can enjoy long term disease free survival with aggressive therapy. Here, Karakiewicz and colleagues examine their multi-institutional experience (17 institutions) with CDRCC treated with nephrectomy, comparing it to a cohort of patients with clear cell RCC (cRCC).

The authors searched a database of 6608 patients treated with radical or partial nephrectomy to identify 41 patients (0.6%) with CDRCC. They were compared to a cohort of 5246 patients with cRCC. To examine cancer specific mortality (CSS) cases of CDRCC were matched 1 to 4 with selected cRCC cases (total 105 patients) for tumor size, grade and TNM stage. The authors found that CDRCC patients were more likely to have advanced stage (76% pT3 vs. 37% in cRCC group), higher grade and were more likely to have lymph node metastases (49% vs. 8% in cRCC group). Patients with CDRCC were more likely to present with metastatic disease (19% vs. 14% in cRCC group), and more likely to present with either local or systemic symptoms related to their tumor (73% vs. 56% in the cRCC group). After matching for stage, grade and tumor size the investigators found no difference in CSS between patients with CDRCC and cRCC (p=0.8, RR1.1). The 5 year CSS was 48% for patients with CDRCC vs. 57% for the matched cRCC cohort.

CDRCC is an aggressive variant of renal cell carcinoma that usually presents at a more advanced stage than patients with cRCC. However, when matched according to stage, grade and tumor size outcomes with surgery are similar between the two histologic subtypes. When found at an early stage, CDRCC patients can have a good outcome when approached with aggressive therapy.

Karakiewicz PI, Trinh QD, Rioux-Leclercq N, de la Taille A, Novara G, Tostain J, Cindolo L, Ficarra V, Artibani W, Schips L, Zigeuner R, Mulders PF, Lechevallier E, Coulange C, Valeri A, Descotes JL, Rambeaud JJ, Abbou CC, Lang H, Jacqmin D, Mejean A, Patard JJ.

European Urology Epub: 2 February 2007.

Reported by UroToday Contributing Editor Christopher G. Wood, MD

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