PURPOSE: Because the prognostic impact of the clinical and pathological features on cancer-specific survival (CSS) and overall survival (OS) in patients with papillary renal cell carcinoma (papRCC) is still controversial, we want to assess the impact of clinicopathological features, including Fuhrman grade and age, on survival in surgically treated papRCC patients in a large multi-institutional series. METHODS: We established a comprehensive multi-institutional database of surgically treated papRCC patients. Histopathological data collected from 2189 patients with papRCC after radical nephrectomy or nephron-sparing surgery were pooled from 18 centres in Europe and North America. OS and CSS probabilities were estimated using the Kaplan-Meier method. Multivariable competing risks analyses were used to assess the impact of Fuhrman grade (FG1-FG4) and age groups (<50 years, 50-75 years, >75 years) on cancer-specific mortality (CSM). RESULTS: CSS and OS rates for patients were 89 and 81% at 3 years, 86 and 75% at 5 years and 78 and 41% at 10 years after surgery, respectively. CSM differed significantly between FG 3 (hazard ratio [HR] 4.22, 95% confidence interval [CI] 2.17-8.22; p < 0.001) and FG 4 (HR 8.93, 95% CI 4.25-18.79; p < 0.001) in comparison to FG 1. CSM was significantly worse in patients aged >75 (HR 2.85, 95% CI 2.06-3.95; p < 0.001) compared to <50 years. CONCLUSIONS: FG is a strong prognostic factor for CSS in papRCC patients. In addition, patients older than 75 have worse CSM than patients younger than 50 years. These findings should be considered for clinical decision making.

Carl Thiem Klinikum Cottbus Cottbus Germany

Centre of Urological Surgery Dialysis and Renal Transplantation Fundeni Clinical Institute Bucharest Romania

Department of Urology and Paediatric Urology Julius Maximilians University Medical Centre of Würzburg Würzburg Germany

Department of Urology ASL Abruzzo 2 Chieti Italy

Department of Urology Faculty Hospital Faculty of Medicine Charles University in Pilsen Pilsen Czech Republic

Department of Urology HELIOS Hospital Bad Saarow Bad Saarow Germany

Department of Urology Instituto Nacional de Cancerologia INCan Mexico City Mexico

Department of Urology Klinikum St Elisabeth Straubing Straubing Germany

Department of Urology Ludwig Maximilians University Campus Grosshadern Marchionistrasse 15 Munich 81377 Germany

Department of Urology Medical University Graz Graz Austria

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology Universitat de Barcelona Hospital Clínic C Villarroel 170 08036 Barcelona Spain

Department of Urology University Hospital Carl Gustav Carus Dresden Germany

Department of Urology University Hospital Heidelberg Heidelberg Germany

Department of Urology University Hospital Mainz Mainz Germany

Department of Urology University of Muenster Medical Center Münster Germany

Hospital Clínic University of Barcelona Barcelona Spain

IRCCS San Raffaele Scientific Institute Department of Urology Vita Salute San Raffaele University Milan Italy

Mannheim Medical Center Department of Urology University of Heidelberg Heidelberg Germany

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