Comparison Of Clinical Features Of Type ? And Type ? Papillary Renal Cell Carcinoma

?Objective?To further improve the understanding of subtypes by comparing clinicopathological features,multiphase CT and prognosis of type ? and type ? papillary renal cell carcinoma(PRCC).?n order to improve the level of PRCC clinical diagnosis and treatment.?Materials and methods?A total of 81 patients previously diagnosed with PRCC in Fujian Provincial Hospital and Fujian Provincial Jinshan Hospital during the period from January,2008 to May 2018 were retrospectively reviewed.Among the 81 patients,31 were type ?,45 were type ?,and 5 were unknown.Based on analysis of clinical data of the two subtypes,the differences in age,gender,tumor size,initial symptoms,treatment,pathological TMN stage,AJCC stage and Fuhrman grading were compared.Multiphase CT was analyzed for HU values and change in HU(?HU)between noncontrast(NC),cortical(C),nephrographic(N),and delayed(D)phases.Prognostic factors were analyzed by applying the Kaplan-Meier Method and the Cox Regression Model was used to further analyze and discuss independent prognostic risk factors.?Results?Among the 76 patients with definite subtype,56 were male while 20 were female,and their average age was 53.1 years old.Most of them were diagnosed by chance,and 40.8% of them were symptomatic.No significant difference were found between the two subtypes in age(P= 0.794),sex(P=0.539),initial symptoms(P= 0.759),and treatment(P= 0.910).The median tumor size for type ? was larger at 4(3-6.2)cm and 3.1(2-5)cm for type ?.At the same time,there were statistical differences between the two groups in pathological TN stage and pathological AJCC stage.?n multiphase CT,There was no difference in HU values for NC(p=0.349),C(p=0.961),N(p=0.742),and D(p=0.781)phases,and in ?HU between C-NC(p=0.768),N-NC(p=0.905),and D-NC(p=0.473).36 cases received radical nephrectomy surgery(14 type ?,22 type ?),38 received nephron sparing surgery(16 type ?,22 type ?),and 2 received radiofrequency ablation.The mean postoperative follow-up time was 50.4 months.One-year cancer specific survival(CSS)rate for type ? PRCC was 100% and for type ? was 95% respectively.Five-year cancer specific survival rate for type ? PRCC was 90% and for type ? was 66.7% respectively.Univariate analysis identified differences between the two subtypes in cancer specific survival(P=0.039)and progression free survival(PFS)(P=0.027).Meanwhile,TNM stage,AJCC stage,as well as Fuhrman grade were risk factors affecting prognosis of PRCC,though multivariate analysis showed that only AJCC stage was the independent risk factor.However,for localized PRCC,there were no significant differences in cancer specific survival(P=0.238)and progression free survival(P = 0.241)between type ? and type ? PRCC.?Conclusions?Compared with type ? PRCC,type ? PRCC has higher clinical stage,Fuhrman grade,larger tumor size and more invasive pathological features,which represent worse prognosis.AJCC stage is the independent risk factor of CSS and PFS.Localized type ? has the same favorable prognosis as type ?.?n terms of imaging,the two subtypes have obvious overlap appearance in multi-stage CT examination which cannot well distinguish the two subtypes in each stage or enhancement.