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Clinical Features, Diagnosis, and Treatment of Collecting Duct Carcinoma of the Kidney
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- The authors performed a retrospective analysis of 19-year period data from two centers to evaluate the imaging and pathological characteristics of collecting duct carcinoma (CDC) of the kidney. Low back pain, hematuria, and fatigue were the most common symptoms among the patients. In total, 32% of the patients had metastasis at presentation, and 17.6% had tumor thrombus. A total of 61 renal surgeries were performed, and the median tumor diameter was found to be 6.5 cm. Of the patients who received immune checkpoint inhibitors, the objective remission rate was 50%. The overall median survival was 24 months.
- Collecting duct carcinoma is highly aggressive and is often diagnosed at advanced stages. Early surgical treatment remains valuable for these patients. Amidst the lack of standard treatment, immune checkpoint inhibitors present new hope for the treatment of CDC.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVE
To comprehensively describe the manifestations, diagnosis, treatment and prognosis of the collecting duct carcinoma (CDC) of the kidney.
MATERIALS AND METHODS
We retrospectively collected data from 74 patients with CDC from two centers between January 2001 and December 2020. The clinical characteristics, imaging and pathological features, and diagnostic and treatment methods were analyzed.
RESULTS
The mean age of the patients was 61.5 years, and 54.1% were males. The most common symptoms were low back pain, hematuria, and fatigue. Computed tomography was not specific, with 10.8% of the patients diagnosed with urothelial carcinoma and 4.1% with infectious disease. Thirty-two patients had metastasis at presentation, while 17.6% had tumor thrombus in the venous system. Twenty-two patients underwent renal biopsy, and 50% of the patients were diagnosed with CDC. Sixty-one renal surgeries were performed, and the pathological median diameter was 6.5 cm. Eight patients received immune checkpoint inhibitors, and the objective remission rate was 50%. The median follow-up time was 16 months, while the median overall survival was 24.0 months. The univariate and multivariable analysis showed that sarcomatoid differentiation and absence of renal surgery were predictors of mortality.
CONCLUSION
CDC is highly aggressive. Patients are commonly diagnosed at an advanced stage. Early surgical treatment can improve prognosis. Though there is still a lack of standard treatment, immune checkpoint inhibitors bring new hope for the treatment of CDC.
Additional Info
Disclosure statements are available on the authors' profiles:
Collecting Duct Carcinoma of the Kidney: Analysis of 74 Cases From Multiple Centers
Urology 2022 Jan 31;[EPub Ahead of Print], J Chen, D Cai, K Gong, S ZhuFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Collecting duct carcinoma (CDC) is one of the most aggressive renal malignancies, with 60% to 70% of the patients dying 1 to 3 years after disease presentation. As CDC accounts for only 1% to 2% of renal cancers and commonly presents symptomatically and at a late stage (with lymph node or distant metastases), there is relatively little evidence regarding its optimal management. This study involving a relatively large series of patients shines some light on the radiographic features present in the majority of CDCs, including low to moderate enhancement (89%), heterogeneity (73%), irregular margins (60%), and an endophytic growth pattern (57%); they can also have calcifications, cystic components, and/or tumor thrombus. CDC was diagnosed in 50% of the renal biopsies when performed, with the remaining 50% of patients undergoing surgery for presumed renal cell carcinoma or urothelial carcinoma. Radical nephrectomy is the mainstay of therapy for localized CDC; even so, recurrence and cancer-specific mortality is commonplace. Median survival was 34 months for patients with localized disease and 11 months for those with distant metastases.
This series offers some guidance on the choice of systemic therapy for CDC, with 3 of 12 patients receiving gemcitabine/cisplatin having a partial response (ORR, 30.8%); the overall response rate was 50% in 8 patients receiving immune checkpoint inhibitors and was 0% with targeted molecular therapy.