March 1, 2007

Second Primary Malignancies Associated With Renal Cell Carcinoma Histological Subtypes While several population-based studies have found an association between renal cancer and lymphoma, few studies have specifically evaluated the association between renal cancer and secondary malignancies using a comprehensive institutional renal cancer database.

In the September issue of the Journal of Urology, Thompson and colleagues from the Mayo Clinic reviewed their database of 2,722 patients who underwent nephrectomy at their institution for sporadic renal cancer over a 30 year-period. The risk of an antecendent, concurrent, or subsequent secondary malignancy was evaluated according to tumor histology.

Tumor histology was distributed as follows: conventional (80.4%), papillary (13.9%), chromophobe (4.7%), collecting duct (0.2%), purely sarcomatoid (0.1%), and unclassified ((0.7%). Median follow-up was approximately 7 years.

Compared with patients exhibiting conventional histology, patients with papillary renal cancer had a higher likelihood of having any secondary malignancy (26.5% vs. 18.5%, p = 0.001) or multiple malignancies (5.6% vs. 1.5%, p < 0.001).

Patients with papillary and chromophobe RCC were also more likely to have colon cancer when compared with conventional histology (3.7% vs. 2.0% and 5.5% vs. 2.0%, respectively, p 0.02). While there was no difference in the incidence of breast cancer by histology, men with papillary RCC exhibited a higher likelihood of prostate cancer when compared with men with conventional histology (15.3% vs. 9.6%, p =0.003).

These data with a cohort of patients treated for renal cancer in a single institution suggest that patients with papillary RCC may have a higher risk of secondary malignancies (particularly of the colon and prostate) when compared to conventional renal cancer. While these conclusions need to be validated in a larger cohort of patients, they underscore the importance of a thorough surveillance protocol including secondary malignancies.

ThompsonВ RH, LeibovichВ BC, ChevilleВ JC, WebsterВ WS, LohseВ CM, KwonВ ED, ZinckeВ H, BluteВ ML
J Urol. 176(3): 900-904, 2006

Reviewed by Contributing Editor Ricardo F. SГЎnchez-Ortiz, MD

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