Korean J Urol.  2006 May;47(5):449-455. 10.4111/kju.2006.47.5.449.

The Clinicopathologic Correlations of Histologic Tumor Necrosis for the Patients with Renal Cell Carcinom

• Chang IH
• Kim TB
• Gil MC
• Kim YJ
• Hong SK
• Byun SS
• Choe G
• Lee SE

• KMID: 2294126
• DOI: http://doi.org/10.4111/kju.2006.47.5.449

Abstract

PURPOSE
The authors investigated the relation of histologic tumor necrosis to the other clinicopathologic factors that are known to be important prognostic indicators for the patients with renal cell carcinoma (RCC).
MATERIALS AND METHODS
The records of 89 patients who were surgically treated for RCC between June 2003 and July 2005 were evaluated for their basic clinical, laboratory and pathologic information, including the TNM classification, the nuclear grade and the Ki-67 expression. The association of the presence and extent of histologic tumor necrosis with the clinical, laboratory and pathologic features, and the Ki-67 labeling index were examined with chi-square tests, Fisher's exact test, Pearson's correlation analysis, Spearman correlation analysis and multivariate logistic regression analysis.
RESULTS
Histologic tumor necrosis was present in 34 of the 89 (38.2%) total RCCs, 24 of 73 (32.9%) conventional RCCs, 9 of 13 (69.2%) papillary RCCs and 1 of 3 (33.3%) chromophobe RCCs. The presence of histologic necrosis in the primary tumor of the patients with RCC compared to the patients with RCC without necrosis was associated with higher levels of anemia, hypercalcemia, hyperalkaline phosphatemia, a higher TNM stage and grade, more perirenal fat invasion, lymphovascular invasion, sarcomatoid change and renal vein thrombosis, a higher Ki-67 labeling index and a larger tumor size. When classifying the RCC according to the histologic subtype, for the conventional RCC, histologic tumor necrosis was associated with the same clinical, laboratory and pathologic features, and the same Ki-67 labelling index as that of the other types of RCCs. The extent of necrosis in the conventional RCC was associated with the TNM stage (r=0.44, p=0.033). Multivariate analysis demonstrated that a higher TNM stage (odd ratio: 5.667; p=0.036; 95% confidence interval: 2.125-63.120) was an independent predictor of histologic tumor necrosis for conventional RCC.
CONCLUSIONS
The presence of histologic necrosis was a predictor of the outcome for conventional RCC, and it should be routinely reported and used in clinical assessment.

Keyword

Tumor; Necrosis; Renal cell carcinoma

MeSH Terms

Anemia
Carcinoma, Renal Cell
Classification
Humans
Hypercalcemia
Logistic Models
Multivariate Analysis
Necrosis*
Renal Veins
Thrombosis

Figure

• 

  Fig. 1 Photomicrographs (hematoxylin and eosin stain) illustrating coagulative tumor necrosis in renal cell carcinoma (RCC). (A) The medium power magnification view showing coagulative tumor necrosis in the conventional RCC. (B) High power magnification view of conventional RCC showing the persistent cellular outlines (arrows). (C) High power magnification view of conventional RCC coagulum of the cellular debris (arrow) adjacent to high grade tumor. (D) Medium power magnification view of papillary RCC showing coagulum tumor necrosis with adjacent cholesterol clefts (arrow). Original magnification: ×200 (A, D); ×400 (B, C).

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