Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Mar-Apr;9(3-4):E172-7.
doi: 10.5489/cuaj.2373.

Clinical outcome and prognostic factors in renal medullary carcinoma: A pooled analysis from 18 years of medical literature

Roberto Iacovelli  1 , Daniela Modica  1 , Antonella Palazzo  1 , Patrizia Trenta  1 , Gabriele Piesco  1 , Enrico Cortesi  1
Affiliations

Clinical outcome and prognostic factors in renal medullary carcinoma: A pooled analysis from 18 years of medical literature

Roberto Iacovelli et al. Can Urol Assoc J. 2015 Mar-Apr.

Abstract

Introduction: We describe clinical features and prognostic factors of renal medullary carcinoma (RMC) by performing a pooled analysis of all reported cases since 1995.

Methods: A systematic search was performed to identify all articles describing patients with medullary renal cancer until February 2013. Survivals were estimated using Kaplan-Meier method with 95% confidence intervals and compared across the groups using the log-rank test. The following factors were evaluated using the Cox proportional hazards model: association of extension of disease at diagnosis, response to therapy, and surgical treatment of primary tumour with overall.

Results: A total 47 articles were selected; these described 165 patients with RMC plus 1 from our centre. The median age was 21 years and 98% of cases had the sickle cell trait. The mean size of the primary tumours was 6.0 cm, with an involvement of loco-regional lymph nodes in 71% of cases. The overall survival at diagnosis was 4.0 months in metastatic patients and 17.0 months in non-metastatic patients. Patients who received platinum-paclitaxel-gemcitabine had longer control of the disease when compared to topoisomerase inhibitors or targeted therapies. The multivariate analysis confirmed that the advanced stage at diagnosis increased the risk of death of about threefold.

Conclusion: RMC is a tumour with poorer prognosis; based on these results, platinum-based chemotherapy is the preferred systemic treatment. Even if radical nephrectomy as an up-front strategy did not report a survival benefit, it may be considered to palliate local symptoms and to perform a correct diagnosis.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Flow-chart of study selection.
Fig. 2.
Fig. 2.
Impact of metastatic stage at diagnosis on overall survival (A) and impact of radical nephrectomy on overall survival (B).
See this image and copyright information in PMC

References

    1. Davis CJ, Mostofi FK, Sesterhenn IA. Renal medullary carcinoma. The seventh sickle cell nephropathy. Am J Surg Pathol. 1995;19:1–11. doi: 10.1097/00000478-199501000-00001. - DOI - PubMed
    1. Khan A, Thomas N, Costello B, et al. Renal medullary carcinoma: Sonographic, computed tomography, magnetic resonance and angiographic findings. Eur J Radiol. 2000;35:1–7. doi: 10.1016/S0720-048X(99)00101-1. - DOI - PubMed
    1. Eble JN, Sauter G, Epstein JI, et al. World Health Organization Classification of Tumours Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. Lyon: IARC Press; 2004.
    1. Davidson AJ, Choyke PL, Hartman DS, et al. Renal medullary carcinoma associated with sickle cell trait: Radiologic findings. Radiology. 1995;195:83–5. doi: 10.1148/radiology.195.1.7892499. - DOI - PubMed
    1. Pham PT, Pham PC, Wilkinson AH, et al. Renal abnormalities in sickle cell disease. Kidney Int. 2000;57:1–8. doi: 10.1046/j.1523-1755.2000.00806.x. - DOI - PubMed