pT1 clear cell renal cell carcinoma

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Abstract
BACKGROUND The majority of patients with pT1 clear cell renal cell carcinoma (RCC) are cured with nephrectomy. However, a few patients will die of RCC. In several studies, MIB‐1 proliferative activity was identified as an independent predictor of survival in patients with RCC. The objective of the current study was to examine MIB‐1 proliferative activity in a large series of patients with pT1 clear cell RCC who were treated uniformly with radical nephrectomy, and to examine the association between proliferative activity and cancer specific survival in a multivariate model incorporating tumor size, nuclear grade, and tumor necrosis. METHODS Patients with solitary pT1 clear cell RCC who underwent radical nephrectomy between 1970–1997 were eligible for the current study. For each of the 40 patients who died of RCC, a stratified random sample of at least 3 year‐matched patients who still were alive or had died of other causes at the time of last follow‐up was selected. Patient age at nephrectomy, patient gender, tumor size, nuclear grade, and tumor necrosis were evaluated, and the MIB‐1 proliferative activity was assessed using digital image analysis. Univariate and multivariate Cox proportional hazards models were fit to assess the features associated with cancer specific survival. The associations between MIB‐1 proliferative activity and pathologic features were assessed using the Wilcoxon rank sum test. RESULTS The mean MIB‐1 value for those patients who died of clear cell RCC was 6.5% compared with 3.6% for those patients who died of other causes or were still alive at the time of last follow‐up. Patients whose tumor had an MIB‐1 proliferative activity ≥ 5.0% were more than twice as likely to die of RCC than patients whose tumors had a MIB‐1 activity < 5% (P = 0.02). However, after adjusting for tumor size, nuclear grade, and necrosis, MIB‐1 proliferative activity was not found to be associated significantly with cancer specific survival. There was a significant association between MIB‐1 proliferative activity and tumor size, nuclear grade, and necrosis. CONCLUSIONS After adjusting for tumor size, nuclear grade, and necrosis, MIB‐1 proliferative activity was not found to be an independent predictor of outcome in patients with pT1 clear cell RCC who were treated with radical nephrectomy. There was a significant association between MIB‐1 and other well established pathologic prognostic features of pT1 clear cell RCC. Cancer 2002;94:2180–4. © 2002 American Cancer Society. DOI 10.1002/cncr.10433