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2015 ; 9
(3-4
): E172-7
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Clinical outcome and prognostic factors in renal medullary carcinoma: A pooled
analysis from 18 years of medical literature
#MMPMID26085875
Iacovelli R
; Modica D
; Palazzo A
; Trenta P
; Piesco G
; Cortesi E
Can Urol Assoc J
2015[Mar]; 9
(3-4
): E172-7
PMID26085875
show ga
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.