Advertisement

Female Gender Predicts Favorable Prognosis in Patients With Non-metastatic Clear Cell Renal Cell Carcinoma Undergoing Curative Surgery: Results From the International Marker Consortium for Renal Cancer (INMARC)

Published:November 06, 2019DOI:https://doi.org/10.1016/j.clgc.2019.10.027

      Abstract

      Background

      There is no clear consensus regarding gender differences in the prognosis of patients with clear-cell renal cell carcinoma (ccRCC). In the present study, we investigated the prognostic value of gender in patients with non-metastatic ccRCC undergoing curative surgery using the inverse probability of treatment weighting (IPTW) method to balance the difference in baseline factors between females and males.

      Patients and Methods

      We retrospectively reviewed the International Marker Consortium for Renal Cancer (INMARC) dataset and included 2055 patients with cT1-4N0M0 ccRCC who underwent partial or radical nephrectomy. The IPTW method was used to adjust for baseline characteristics between females and males (age, race, surgery type, and pT stage), and the association of gender with recurrence-free survival (RFS) was evaluated.

      Results

      During the follow-up (median, 30 months), 162 (8%) patients had disease recurrence (5-year RFS rate, 88%). Female gender (n = 712; 35%) was significantly associated with a lower Fuhrman grade (unweighted, P = .022; IPTW-weighted, P < .001). Females had significantly better RFS compared with males (unweighted, 5-year RFS rate, 92% vs. 87%; P = .005; IPTW-weighted, 5-year RFS rate, 92% vs. 86%; P = .002). IPTW-weighted multivariate analysis showed that female gender was an independent predictor for better RFS (hazard ratio, 0.59; P = .005) along with lower pT stage and lower Fuhrman grade. The prognostic significance of female gender was also observed in the unweighted multivariate analysis.

      Conclusion

      Female gender was significantly associated with a lower Fuhrman grade and better prognosis for patients with non-metastatic ccRCC undergoing curative surgery.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Genitourinary Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2018.
        CA Cancer J Clin. 2018; 68: 7-30
        • Aron M.
        • Nguyen M.M.
        • Stein R.J.
        • Gill I.S.
        Impact of gender in renal cell carcinoma: an analysis of the SEER database.
        Eur Urol. 2008; 54: 133-140
        • Ljungberg B.
        • Campbell S.C.
        • Choi H.Y.
        • et al.
        The epidemiology of renal cell carcinoma.
        Eur Urol. 2011; 60: 615-621
        • Lee S.
        • Jeon H.G.
        • Kwak C.
        • et al.
        Gender-specific clinicopathological features and survival in patients with renal cell carcinoma (RCC).
        BJU Int. 2012; 110: E28-E33
        • Onishi T.
        • Oishi Y.
        • Goto H.
        • Yanada S.
        • Abe K.
        Gender as a prognostic factor in patients with renal cell carcinoma.
        BJU Int. 2002; 90: 32-36
        • Woldrich J.M.
        • Mallin K.
        • Ritchey J.
        • Carroll P.R.
        • Kane C.J.
        Sex differences in renal cell cancer presentation and survival: an analysis of the National Cancer Database, 1993-2004.
        J Urol. 2008; 179: 1709-1713
        • Srigley J.R.
        • Delahunt B.
        • Eble J.N.
        • et al.
        ISUP Renal Tumor Panel. The International Society of Urological Pathology (ISUP) Vancouver classification of renal neoplasia.
        Am J Surg Pathol. 2013; 37: 1469-1489
        • Koul H.
        • Huh J.S.
        • Rove K.O.
        • et al.
        Molecular aspects of renal cell carcinoma: a review.
        Am J Cancer Res. 2011; 1: 240-254
        • Austin P.C.
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivariate Behav Res. 2011; 46: 399-424
        • Fuhrman S.A.
        • Lasky L.C.
        • Limas C.
        Prognostic significance of morphologic parameters in renal cell carcinoma.
        Am J Surg Pathol. 1982; 6: 655-663
        • Edge S.B.
        • American Joint Committee on Cancer, American Cancer Society
        AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual.
        7th ed. Springer, New York2010: 479-486
        • Crawford B.M.
        • Meana M.
        • Stewart D.
        • Cheung A.M.
        Treatment decision making in mature adults: gender differences.
        Health Care Women Int. 2000; 21: 91-104
        • Regitz-Zagrosek V.
        Sex and gender differences in health. Science & society series on sex and science.
        EMBO Rep. 2012; 13: 596-603
        • Bertakis K.D.
        • Azari R.
        • Helms L.J.
        • Callahan E.J.
        • Robbins J.A.
        Gender differences in the utilization of health care services.
        J Fam Pract. 2000; 49: 147-152
        • Wang K.
        • Sun Y.
        • Tao W.
        • Fei X.
        • Chang C.
        Androgen receptor (AR) promotes clear cell renal cell carcinoma (ccRCC) migration and invasion via altering the circHIAT1/miR-195-5p/29a-3p/29c-3p/CDC42 signals.
        Cancer Lett. 2017; 394: 1-12
        • He D.
        • Li L.
        • Zhu G.
        • et al.
        ASC-J9 suppresses renal cell carcinoma progression by targeting an androgen receptor-dependent HIF2alpha/VEGF signaling pathway.
        Cancer Res. 2014; 74: 4420-4430
        • Ha Y.S.
        • Lee G.T.
        • Modi P.
        • et al.
        Increased expression of androgen receptor mRNA in human renal cell carcinoma cells is associated with poor prognosis in patients with localized renal cell carcinoma.
        J Urol. 2015; 194: 1441-1448
        • Yu C.P.
        • Ho J.Y.
        • Huang Y.T.
        • et al.
        Estrogen inhibits renal cell carcinoma cell progression through estrogen receptor-beta activation.
        PLoS One. 2013; 8: e56667
        • Rodriguez-Covarrubias F.
        • Gomez-Alvarado M.O.
        • Sotomayor M.
        • et al.
        Time to recurrence after nephrectomy as a predictor of cancer-specific survival in localized clear-cell renal cell carcinoma.
        Urol Int. 2011; 86: 47-52
        • Brookman-May S.D.
        • May M.
        • Shariat S.F.
        • et al.
        Members of the CORONA-Project; Members of the SATURN-Project; Young Academic Urologists Renal Cancer Group. Time to recurrence is a significant predictor of cancer-specific survival after recurrence in patients with recurrent renal cell carcinoma–results from a comprehensive multi-centre database (CORONA/SATURN-Project).
        BJU Int. 2013; 112: 909-916
        • Thoroddsen A.
        • Einarsson G.V.
        • Hardarson S.
        • et al.
        Renal cell carcinoma in young compared to older patients: comparison of clinicopathological risk factors and survival.
        Scand J Urol Nephrol. 2008; 42: 121-125
        • Komai Y.
        • Fujii Y.
        • Iimura Y.
        • et al.
        Young age as favorable prognostic factor for cancer-specific survival in localized renal cell carcinoma.
        Urology. 2011; 77: 842-847
        • Kutikov A.
        • Egleston B.L.
        • Canter D.
        • Smaldone M.C.
        • Wong Y.N.
        • Uzzo R.G.
        Competing risks of death in patients with localized renal cell carcinoma: a comorbidity based model.
        J Urol. 2012; 188: 2077-2083