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Correlation between coagulative tumor necrosis and clinicopathologic parameters in clear cell renal cell carcinoma

Snezhana Spasova, Peter Ghenev


Introduction: Tumor necrosis (TN) has been repeatedly associated with larger tumors, higher grade, and higher proliferative activity, and, although the pathogenesis of TN remains largely unknown, it is believed that TN represents an indirect indicator of biologically aggressive tumor behavior.

Aim: Them aim of study is to examine the presence of necrotic areas in metastatic and non metastatic clear cell renal cell carcinoma (ccRCC).

Materials and Methods: This analysis included data from 43 patients who underwent a radical nephrectomy. The pathologic features studied included histologic subtype, tumor size, regional lymph node involvement, distant metastases, TNM stage groupings, nuclear grade, and coagulative tumor necrosis. The extent of tumor necrosis was semiquantitatively assessed and recorded as absent, focal (<10% of the tumor area), moderate (10%-30% of the tumor area) or extensive (>30% of the tumor area). TN was defined as the presence of microscopic coagulative necrosis, characterized by homogeneous clusters and sheets of degenerating and dead cells. Histopathologic regressive changes, such as cystic transformation, hyalinization, and fibrosis, were not considered to represent necrosis. The relationship between TN and other clinicopathologic parameters was studied by nonparametric tests.

Results: Necrosis was found in all cases with metastases. In cases without metastase, necroses were found in only 5 (16%). The presence of TN was statistically significantly associated with the presence of metastases, high T stage, large tumor size, poor differentiation (p<0.05). No statistically significant association between age or sex and the presence of TN was observed.

Conclusion: It is clear that coagulative tumor necrosis is a prognostic marker that can be readily applied in combination with more traditional variables (i.e., tumor size, TNM stage, and nuclear grade) to enhance the performance of renal cell carcinoma scoring algorithms and predictive models currently in use to help assign follow-up and treatment in the clinical setting.


clear cell renal cell carcinoma; coagulative tumor necrosis; clinicopathologic parameters

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