Whether histologic subtyping affect the oncological outcomes of patients with papillary renal cell carcinoma: evidence from a systematic review and meta-analysis

Shengwei Xiong; Weijie Zhu; Xinfei Li; Yanfei Yu; Kunlin Yang; Lei Zhang; Yue Mi; Xuesong Li; Liqun Zhou

doi:10.21037/tau-21-329

Whether histologic subtyping affect the oncological outcomes of patients with papillary renal cell carcinoma: evidence from a systematic review and meta-analysis

Transl Androl Urol. 2021 Aug;10(8):3255-3266. doi: 10.21037/tau-21-329.

Authors

Shengwei Xiong¹, Weijie Zhu¹, Xinfei Li¹, Yanfei Yu¹, Kunlin Yang¹, Lei Zhang¹, Yue Mi¹, Xuesong Li¹, Liqun Zhou¹

Affiliation

¹ Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, Beijing, China.

Abstract

Background: Whether the histologic subtype (type 1 and type 2) of papillary renal cell carcinoma (pRCC) is a tool to predict the prognosis is of great debate. This study is aimed to evaluate the prognostic significance of histologic subtype in patients with pRCC after surgery through a systematic review and meta-analysis.

Methods: We searched PubMed, the Web of Science, Cochrane library and EMBASE databases to identify studies published until January 20, 2021 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were deemed eligible if they compared the overall survival (OS), cancer specific survival (CSS), recurrence-free survival (RFS) or disease-free survival (DFS) between patients with type 1 or type 2 pRCC. And the corresponding hazard ratios (HRs) and 95% conference intervals (CIs) were collected for meta-analysis and further subgroup analysis.

Results: Overall 22 studies with a total of 4,494 patients were considered eligible and included for the systematic review and meta-analysis. The pooled results showed that type 2 pRCC was associated with a worse OS (pooled HR 1.61, 95% CI: 1.10-2.36, P=0.02) and CSS (pooled HR 1.59, 95% CI: 1.00-2.51, P=0.05). However, the subgroup analysis yielded the same result as the initial analysis only when the HRs were extracted from univariate analysis. In studies with multivariate analysis, type 2 pRCC was not statistically associated with a worse OS (pooled HR 1.22, 95% CI: 0.97-1.53, P=0.27), CSS (pooled HR 1.16, 95% CI: 0.67-2.00, P=0.60), and DFS (pooled HR 1.33, 95% CI: 0.93-1.91, P=0.12) compared to type 1 pRCC.

Discussion: Histologic subtype is not an independent prognostic factor for patients with pRCC, although the result needs to be taken with caution. And studies with retrospective study design, larger sample size and longer follow-up period are required to verify these results.

Keywords: Papillary renal cell carcinoma (pRCC); histologic subtype; meta-analysis; prognosis.