Does histologic subtype impact overall survival in observed T1a kidney cancers compared with competing risks? Implications for biopsy as a risk stratification tool

Objectives We sought to assess if adding a biopsy proven histologic subtype to a model that predicts overall survival that includes variables representing competing risks in observed, biopsy proven, T1a renal cell carcinomas, enhances the model's performance. Methods The National Cancer Databas...

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Bibliographic Details
Published in:International journal of urology 2022-08, Vol.29 (8), p.845-851
Main Authors: Michael, Jamie, Velazquez, Nermarie, Renson, Audrey, Tan, Hung‐Jui, Rose, Tracy L, Osterman, Chelsea K, Milowsky, Matthew, Kang, Stella K, Huang, William C, Bjurlin, Marc A
Format: Article
Language:English
Subjects:
active surveillance
Biopsy
histologic subtype
Histology
Kidney cancer
Kidneys
observation
overall survival
Renal cell carcinoma
T1a
Tumors
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Summary:Objectives We sought to assess if adding a biopsy proven histologic subtype to a model that predicts overall survival that includes variables representing competing risks in observed, biopsy proven, T1a renal cell carcinomas, enhances the model's performance. Methods The National Cancer Database was assessed (years 2004–2015) for patients with observed T1a renal cell carcinoma who had undergone renal mass biopsy. Kaplan–Meier curves were utilized to estimate overall survival stratified by histologic subtype. We utilized C‐index from a Cox proportional hazards model to evaluate the impact of adding histologic subtypes to a model to predict overall survival for each stage. Results Of 132 958 T1a renal masses identified, 1614 had biopsy proven histology and were managed non‐operatively. Of those, 61% were clear cell, 33% papillary, and 6% chromophobe. Adjusted Kaplan–Meier curves demonstrated a difference in overall survival between histologic subtypes (P = 0.010) with greater median overall survival for patients with chromophobe (85.1 months, hazard rate 0.45, P = 0.005) compared to clear cell (64.8 months, reference group). Adding histology to a model with competing risks alone did not substantially improve model performance (C‐index 0.65 vs 0.64 respectively). Conclusions Incorporation of histologic subtype into a risk stratification model to determine prognostic overall survival did not improve modeling of overall survival compared with variables representing competing risks in patients with T1a renal cell carcinoma managed with observation. These results suggest that performing renal mass biopsy in order to obtain tumor histology may have limited utility. Future studies should further investigate the overall utility of renal mass biopsy for observed T1a kidney cancers.
ISSN:0919-8172
1442-2042
DOI:10.1111/iju.14910