Advertisement
Journal of Clinical Oncology  
Search for:
Limit by:
  Browse by Subject or Issue
Home Search or Browse JCO My JCO Subscriptions Customer Service Site Map

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Save to my personal folders
Right arrow Download to citation manager
Right arrowRights & Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Motzer, R. J.
Right arrow Articles by Reuter, V.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Motzer, R. J.
Right arrow Articles by Reuter, V.
Journal of Clinical Oncology, Vol 20, Issue 9 (May), 2002: 2376-2381
© 2002 American Society for Clinical Oncology

Treatment Outcome and Survival Associated With Metastatic Renal Cell Carcinoma of Non–Clear-Cell Histology

By Robert J. Motzer, Jennifer Bacik, Tania Mariani, Paul Russo, Madhu Mazumdar, Victor Reuter

From the Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine; and Departments of Epidemiology and Biostatistics, Urology, and Pathology, Memorial Sloan-Kettering Cancer Center; and Department of Medicine, Cornell University Medical College, New York, NY.

Address reprint requests to Robert J. Motzer, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; email: motzerr{at}mskcc.org


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
PURPOSE: To define outcome data for patients with metastatic renal cell carcinoma (RCC) with histology other than clear-cell type, including collecting duct (or medullary carcinoma), papillary, chromophobe, and unclassified histologies.

PATIENTS AND METHODS: Sixty-four patients with metastatic non–clear-cell RCC histology were the subjects of this retrospective review. Included in the analysis were 22 (8%) of 286 patients from a clinical trials database, 19 of 1,166 patients from a surgery database, and 23 of 357 patients from a pathology database.

RESULTS: The prevalent histology was collecting duct, present in 26 (41%) patients. The number of patients with chromophobe and papillary histologies was 12 (19%) and 18 (28%), respectively. Eight (12%) of the patients had tumors that could not be classified for specific tumor histology. Among the 43 patients treated with 86 systemic therapies, including 37 cytokine therapies, two patients (5%) were observed to have a partial response. The median overall survival time was 9.4 months (95% confidence interval, 8 to 14 months). The survival was longer for patients with chromophobe tumors compared with collecting duct or papillary histology, and this group included four patients with survival of greater than 3 years.

CONCLUSION: RCC consists of a heterogeneous group of tumors including clear-cell, papillary, chromophobe, collecting duct, and unclassified cell types. Non–clear-cell histologies constitute less than 10% of patients in general populations of patients with advanced RCC treated on clinical trials. Metastatic non–clear-cell RCC is characterized by a resistance to systemic therapy and poor survival, with the survival for patients with chromophobe tumors longer than that for patients with metastatic collecting duct or papillary RCC. Treatment with novel agents on clinical trials is warranted.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
RECENT PROGRESS IN understanding the immunohistochemical and genetic features of renal cell carcinoma (RCC) has facilitated classification into clear (conventional), papillary, chromophobe, collecting duct, and medullary cell types.1-6 Clear-cell is recognized as the predominant cell type, constituting approximately 60% of renal epithelial tumors.2 The remaining renal neoplasms consist of papillary (7% to 14%), chromophobe (6% to 11%), oncocytoma (7% to 10%), collecting duct, and medullary cell types (< 1%).2 After nephrectomy for a localized primary tumor, papillary and chromophobe cell types portend a favorable prognosis compared with the clear-cell type, and oncocytoma is considered a benign neoplasm.2,7 In contrast, collecting duct (Bellini duct) and medullary carcinoma are highly aggressive neoplasms that generally present with metastases.1

Metastatic RCC is characterized by poor prognosis and a resistance to systemic chemotherapy.8,9 Immunotherapy with interleukin-2 and/or interferon alfa-2a achieves responses in 10% to 20% of patients.10,11 Also, a modest survival benefit for this therapy in metastatic RCC has been cited in two recent phase III trials comparing interferon alfa-2a to vinblastine or medroxyprogesterone.12,13

Reports of clinical trials in metastatic RCC do not distinguish between clear and non–clear-cell types.8 Responsiveness of advanced RCC to immunotherapy by specific cell type remains to be established. Also, reports of clinical features and outcome for patients with metastatic non–clear-cell histologies of the kidney consist of small series and case reports limited to patients with collecting duct and medullary carcinomas.14-22 We performed a retrospective analysis and report on clinical features, treatment outcome, and survival for 64 patients with metastatic papillary, chromophobe, and collecting duct carcinoma, or unclassified RCC.


   PATIENTS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Sixty-four patients with metastatic non–clear-cell RCC histology who underwent clinical evaluation at Memorial Sloan-Kettering Cancer Center (MSKCC) from October 1985 to May 2001 were the subjects of this retrospective review. All had review of pathologic findings at MSKCC showing papillary, chromophobe, collecting duct (or medullary), or unclassified cell types of RCC, and absence of clear-cell histology; clinical evaluation at MSKCC showing metastases; and follow-up data. No distinction was made between medullary cell type and collecting duct carcinoma, because the two are difficult to distinguish by morphology.

Patients were identified from three databases. The initial query was performed on a clinical trials database of 286 patients with advanced/metastatic disease who had primary site of RCC and who were treated on institutional review board–approved clinical trials at MSKCC. This query identified 22 patients meeting the eligibility criteria (8%), 20 who received treatment from April 1994 to 2001 and two who received treatment in 1992. The second was a surgical database of 1,166 patients undergoing nephrectomy or exploratory laparotomy with biopsy at MSKCC between 1989 and 1999. Nineteen additional patients were identified. The third query was performed on a pathology database consisting of 357 cases of metastatic or nonmetastatic non–clear-cell RCC ascertained between 1985 and 2001. This query retrieved 23 additional patients. It was not expected that patients from the three databases would differ in a systematic manner.

The entry point for this analysis was defined as date of protocol entry for patients treated on a prospective clinical trial, and date of initial evaluation at the center in the setting of clinically evident metastatic disease for the remaining patients. Clinical features at study entry, systemic therapy, assessment of response, date of last follow-up, and status were recorded. Systemic therapy was categorized as cytokine (interferon alfa-2a, interleukin-2) versus other therapies. Other therapies included conventional cytotoxic drugs or novel agents on phase I or II trials. Conventional drugs included gemcitabine, cisplatin, 5-fluorouracil, vinblastine,23 or medroxyprogesterone. New agents in clinical trials included suramin,24 arsenic trioxide,25 thalidomide,26 and irofulven.27 Survival time was defined as the time from point of entry to the date of death or last follow-up. Survival distributions were estimated using Kaplan-Meier methodology.28


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
DISCUSSION
 REFERENCES
 
Patient Characteristics
Median age for the 64 patients was 52 years, and 58% were male (Table 1). The most frequent histology was collecting duct, present in 26 (41%) patients. The number of patients with chromophobe and papillary histologies was 12 (19%) and 18 (28%), respectively. Eight (12%) of the patients had tumors that could not be classified for specific histology. Fifty-two (81%) patients had a prior nephrectomy.


View this table:
[in this window]
[in a new window]
  		Table 1.  Patient Histologies and Characteristics
 
Patient characteristics by individual histology are listed in Table 2. Patients with papillary, chromophobe, and unclassified histologies were predominantly male, with median age in the fifth and sixth decades. Fifty-eight percent of patients with collecting duct tumors were female and 19% were African-American. Predominant race for the remaining histologies was white, non-Hispanic.


View this table:
[in this window]
[in a new window]
  		Table 2.  Patient Characteristics by Pathology
 
Forty-two percent of patients with collecting duct tumors had three or more metastatic sites. Retroperitoneal lymph node and lung parenchyma were the most common metastatic sites (46% and 42%, respectively), but metastases to liver and bone were noted in 31% and 35% of patients, respectively.

Chromophobe tumors were associated with a relatively low proportion of patients with lung metastases (two of 12) and a high proportion (58%) of patients with one metastatic site. The most common site of metastases for patients with papillary histology was retroperitoneal lymph nodes.

Treatment and Response
Thirty-one patients (48%) were treated with cytokine therapy consisting of interferon alfa-2a, interleukin-2, or combination (Table 3). Thirty patients were treated with a chemotherapy agent, hormone, or novel agent on a clinical trial. Among the 43 patients treated with 86 systemic therapies, including 37 cytokine therapies, two patients (5%) were observed to have a partial response. One patient with chromophobe histology achieved a partial response to interferon alfa-2a and remained progression-free for 30 months. A second patient with collecting duct tumor achieved a partial response of 5 months to treatment with gemcitabine plus cisplatin. Patients were assessable for response to 81 of 86 systemic therapies given, but no other treatment was associated with complete or partial response.


View this table:
[in this window]
[in a new window]
  		Table 3.  Systemic Therapy by Histology
 
The proportion of cytokine therapies resulting in a response was zero of 15 (95% confidence interval [CI], 0% to 22%) for 13 patients with collecting duct and one of 12 (95% CI, 0.2% to 39%) for one patient with chromophobe histology.

Survival Distribution
The median overall survival time was 9.4 months (95% CI, 8 to 14 months) (Table 4 and Fig 1). Survival was addressed specifically for the three most frequent histologies (Table 4 and Fig 2). The median survival for patients with collecting duct and papillary histologies was 11 and 5.5 months, respectively. Survival was longer for patients with chromophobe tumors (median, 29 months) compared with collecting duct or papillary histology. Four of five patients with survival greater than 3 years had chromophobe histology (Fig 2).


View this table:
[in this window]
[in a new window]
  		Table 4.  Patient Survival for All Patients and According to Chromophobe, Collecting Duct, and Papillary Histology
 


View larger version (14K):
[in this window]
[in a new window]
  		Fig 1. Patient survival curve for 64 patients (10 alive). Tick marks indicate last follow-up.

 


View larger version (21K):
[in this window]
[in a new window]
  		Fig 2. Patient survival curve by histology of chromophobe (12 patients, four alive), collecting duct (26 patients, four alive), and papillary histology (18 patients, two alive). Tick marks indicate last follow-up.

 

   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
REFERENCES
 
RCC consists of several cell types that warrant consideration in the design and interpretation of clinical trials for patients with advanced disease. These tumors have different clinical features and survival potential, and may respond differently to therapy. The experience at MSKCC suggests that the relative proportion of patients with non–clear-cell metastatic RCC treated on clinical trials is less than 10%. In this series, 22 of 286 (8%) patients with RCC treated on clinical trials with multiple agents had disease of non–clear-cell histology. We have previously cited a pathology review of 109 patients treated with interferon alfa-2a at MSKCC on a phase III trial (included in this series),29 and identified eight (7%) patients with non–clear-cell histology (six chromophobe, two collecting duct).

In a series of 670 patients who had nephrectomy at MSKCC for a localized renal tumor, clear-cell was the predominant cell type.30 However, the histology in 42% of renal neoplasms was non–clear-cell, which included 18% papillary, 12% oncocytoma, 6% chromophobe, and 6% unclassified cell types.30 The proportion of patients with non–clear-cell histology on clinical trials for patients with metastases was less compared with our experience of patients treated by nephrectomy. This may reflect the favorable prognosis associated with several of these histologies amenable to surgical resection and patient selection factors. In that setting, oncocytoma is regarded as a benign tumor, and the 5-year survival of patients with chromophobe and papillary RCC treated with nephrectomy approximates 90% or higher.2,31,32

In contrast, the median survival of the 64 patients with metastatic non–clear-cell RCC was 9.4 months, and only five patients survived for greater than 3 years. When considered by specific cell type, the median survival of patients with papillary and collecting duct tumors was 5.5 and 11 months, respectively. Small series and case reports of metastatic collecting duct tumors have reported this tumor to be associated with widespread metastases at presentation and a short survival.14-22 The relatively favorable prognosis associated with localized papillary RCC treated with nephrectomy2 was not evident in the survival of patients with distant metastases. The survival of patients with metastatic chromophobe tumors was longer (median, 29 months) compared with other non–clear-cell histologies. Also, long-term survival of 36 months or greater in our series was observed in four patients with this tumor type.

None of the multiple chemotherapy or cytokine therapies used in the treatment of these patients resulted in substantial antitumor activity. Response to interferon alfa-2a, interleukin-2, or the combination was noted in only one patient with metastatic chromophobe RCC. One other series of 12 patients with metastatic collecting duct RCC reported a patient with response to interferon alfa-2a and interleukin-2.17 Although we cannot exclude antitumor activity for specific RCC subtypes studied, evidence that a particular cell type is associated with substantial antitumor activity was not apparent.

Published data on responsiveness of RCC to immunotherapy by cell type is lacking, and the possibility that therapeutic benefit may be largely limited to clear-cell type warrants further study. In this regard, the routine use of potentially highly toxic cytokine therapies such as high-dose intravenous bolus interleukin-2 therapy33 must be carefully considered before being offered to patients with non–clear-cell RCC.

Cytotoxic chemotherapy derived from successful treatment of urothelial tumors has previously been used in patients with collecting duct carcinoma without success.31 We observed one patient who achieved a partial response to gemcitabine plus cisplatin. Recently, a patient who achieved a partial response to gemcitabine plus doxorubicin has been reported.34 These responses are anecdotal and of brief duration, because collecting duct carcinoma is a malignancy that is highly refractory to systemic therapy. When the histology cannot be distinguished from poorly differentiated transitional cell carcinoma, a trial of chemotherapy directed at urothelial cancer may be considered.

Otherwise, patients with these unusual RCC histologies should be treated on clinical trials of novel agents. Also, the molecular profile of these tumors may provide the rationale for a specific therapy. For example, papillary RCC is characterized by mutations in the MET proto-oncogene,35,36 which may be a target for directed therapy.37

No distinction was made in our series between medullary and collecting duct carcinomas, because these tumors share many morphologic features.2 In fact, medullary carcinoma is believed to be a particularly virulent form of collecting duct carcinoma.2 A distinct feature of medullary carcinoma is its association with sickle cell trait, whether of African-American, Mediterranean, or other ancestry.22,38 The relatively high proportion of African-Americans among patients with collecting duct tumors in our series may reflect this diagnosis.

In summary, non–clear-cell RCC consists of a heterogeneous group of tumors consisting of papillary, chromophobe, collecting duct, and unclassified cell types. The experience at MSKCC suggests that these tumors constitute less than 10% of patients in general populations of patients with advanced RCC treated on clinical trials. Metastatic non–clear-cell RCC is characterized by a resistance to systemic therapy and poor survival, with the survival for patients with chromophobe tumors longer than that of patients with metastatic collecting duct or papillary RCC. The survival of patients with chromophobe and papillary cell types warrants further study in a larger series.


   ACKNOWLEDGMENTS
 
Supported in part by National Institutes of Health grant nos. K24 CA82431 and CA-05826.

We thank Carol Pearce for review of the manuscript.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 PATIENTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
1. Motzer RJ, Bander NH, Nanus DM: Renal-cell carcinoma. N Engl J Med 335: 865-875, 1996[Free Full Text]

2. Reuter VE, Presti JC: Contemporary approach to the classification of renal epithelial tumors. Semin Oncol 27: 124-137, 2000[Medline]

3. van den Berg E, Van der Hout AH, Oosterhuis JW, et al: Cytogenetic analysis of epithelial renal-cell tumors: Relationship with a new histopathological classification. Int J Cancer 55: 223-227, 1993[Medline]

4. Weiss LM, Gelb AB, Medeiros LJ: Adult renal epithelial neoplasms. Am J Clin Pathol 40: 171-180, 1995

5. Kovacs G, Szucs S, deRiese W, et al: Specific chromosome aberrations in human renal cell carcinoma. Int J Cancer 40: 171-180, 1987[Medline]

6. Fleming S: The impact of genetics for the classification of renal carcinoma. Histopathology 22: 89-92, 1993[Medline]

7. Kattan MW, Reuter VE, Motzer RJ, et al: A post-operative prognostic nomogram for renal cell carcinoma. J Urol 166: 63-67, 2001[CrossRef][Medline]

8. Motzer RJ, Russo P: Systemic therapy for renal cell carcinoma. J Urol 163: 408-417, 2000[CrossRef][Medline]

9. Vogelzang NJ, Stadler WM: Kidney cancer. Lancet 352: 1691-1696, 1998[CrossRef][Medline]

10. Bukowski R: Immunotherapy in renal cell carcinoma. Oncology 13: 801-813, 1999[Medline]

11. Figlin RA: Renal cell carcinoma: Management of advanced disease. J Urol 161: 381-387, 1999[CrossRef][Medline]

12. Pyrhonen S, Salminen E, Ruutu M, et al: Prospective randomized trial of interferon alfa-2a plus vinblastine versus vinblastine alone in patients with advanced renal cell cancer. J Clin Oncol 17: 2859-2867, 1999[Abstract/Free Full Text]

13. Medical Research Council and Collaborators: Interferon-alpha and survival in metastatic renal carcinoma: Early results of a randomised controlled trial. Lancet 353: 14-17, 1999[CrossRef][Medline]

14. Carter MD, Tha S, McLoughlin MG, et al: Collecting duct carcinoma of the kidney: A case report and review of the literature. J Urol 147: 1096-1098, 1992[Medline]

15. Kirkali Z, Celebi I, Akan G, et al: Bellini duct (collecting duct) carcinoma of the kidney. Urology 47: 921-923, 1996[CrossRef][Medline]

16. Kennedy S, Meino M, Linehan WM, et al: Collecting duct carcinoma of the kidney. Hum Pathol 21: 449-455, 1990[CrossRef][Medline]

17. Dimopoulos MA, Logothetis CJ, Markowitz A, et al: Collecting duct carcinoma of the kidney. Br J Cancer 71: 388-391, 1993

18. Fukunaga M: Sarcomatoid collecting duct carcinoma. Arch Pathol Lab Med 123: 338-341, 1999[Medline]

19. Auguet T, Molina JC, Lorenzo AVJ, et al: Synchronous renal cell carcinoma and Bellini duct carcinoma: A case report on a rare coincidence. World J Urol 18: 449-451, 2000[CrossRef][Medline]

20. Olivere JW, Cina SJ, Rastogi P, et al: Collecting duct meningeal carcinomatosis. Arch Pathol Lab Med 123: 638-641, 1999[Medline]

21. Pickhardt P, Siegel C, McLarney JK: Collecting duct carcinoma of the kidney: Are imaging findings suggestive of the diagnosis. AJR Am J Roentgenol 176: 627-633, 2001[Abstract/Free Full Text]

22. Figenshau S, Basler J, Ritter J, et al: Renal medullary carcinoma. J Urol 159: 711-713, 1998[CrossRef][Medline]

23. Motzer RJ, Lyn P, Fischer P, et al: Phase I/II trial of dexverapamil plus vinblastine for patients with advanced renal cell carcinoma. J Clin Oncol 13: 1958-1965, 1995[Abstract/Free Full Text]

24. Motzer RJ, Nanus DM, O’Moore P, et al: Phase II trial of suramin in patients with advanced renal cell carcinoma: Treatment results, pharmacokinetics, and tumor growth factor expression. Cancer Res 52: 5775-5779, 1992[Abstract/Free Full Text]

25. Vuky J, Yu R, Schwartz L, et al: Phase II trial of arsenic trioxide in patients with metastatic renal cell carcinoma. Invest New Drugs (in press)

26. Motzer RJ, Berg W, Ginsberg M, et al: Phase II trial of thalidomide for patients with advanced renal cell carcinoma. J Clin Oncol 20: 302-306, 2002[Abstract/Free Full Text]

27. Berg WJ, Schwartz L, Yu R, et al: Phase II trial of irofulven (6-hydroxymethaylacylfulvene) for patients with advanced renal cell carcinoma. Invest New Drugs 19: 317-320, 2001[CrossRef][Medline]

28. Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: 457-481, 1958[CrossRef]

29. Motzer RJ, Murphy B, Bacik J, et al: Phase III trial of interferon alfa-2a with or without 13-cis-retinoic acid for patients with advanced renal cell carcinoma. J Clin Oncol 18: 2972-2980, 2000[Abstract/Free Full Text]

30. Lee CT, Katz J, Shi W, et al: Surgical management of renal tumors 4cm or less in a contemporary cohort. J Urol 163: 730-736, 2000[CrossRef][Medline]

31. Amin MB, Crotty TB, Tickoo SK, et al: Renal oncocytoma: A reappraisal of morphologic features with clinicopathologic findings in 80 cases. Am J Surg Pathol 21: 1-12, 1997[CrossRef][Medline]

32. Tickoo SK, Reuter VE: Subtyping of papillary renal cell carcinoma: A clinicopathologic study of 103 cases—90th Annual Meeting, USCAP (Atlanta). Mod Pathol 14: 124A, 2001

33. Rosenberg SA, Lotze MT, Yang JC, et al: Prospective randomized trial of high-dose interleukin-2 alone or in conjunction with lymphokine-activated killer cells for the treatment of patients with advanced cancer. J Natl Cancer Inst 85: 622-632, 1993[Abstract/Free Full Text]

34. Milowsky MI, Rosmarin AS, Tickoo S, et al: Active chemotherapy for collecting duct carcinoma of the kidney. Proc Am Soc Clin Oncol 20: 164b, 2001 (abstr 2405)

35. Schmidt L, Duh F, Chen F, et al: Germline and somatic mutations in the tyrosine kinase domain of the MET proto-oncogene in papillary renal carcinomas. Nat Genet 16: 68-69, 2001

36. Schmidt L, Junker K, Nakaigawa N, et al: Novel mutations of the MET proto-oncogene in papillary renal carcinomas. Oncogene 18: 2343-2350, 1999[CrossRef][Medline]

37. Webb C, Hose C, Koochekpour S, et al: The geldanamycins are potent inhibitors of the hepatocyte growth factor/scatter factor-met-urokinase plasminogen activator-plasmin proteolytic network. Cancer Res 60: 342-349, 2000[Abstract/Free Full Text]

38. Davis CJ, Mostofi FK, Sesterhenn I: Renal medullary carcinoma: The seventh sickle cell nephropathy. Am J Surg Pathol 19: 1-11, 1995[Medline]

Submitted November 26, 2001; accepted February 11, 2002.




This article has been cited by other articles:


Home page
 JCOHome page
D. Strumberg
Efficacy of Sunitinib and Sorafenib in Non-Clear Cell Renal Cell Carcinoma: Results From Expanded Access Studies
J. Clin. Oncol., July 10, 2008; 26(20): 3469 - 3471.
[Full Text] [PDF]

Home page
 JCOHome page
T. K. Choueiri, A. Plantade, P. Elson, S. Negrier, A. Ravaud, S. Oudard, M. Zhou, B. I. Rini, R. M. Bukowski, and B. Escudier
Efficacy of Sunitinib and Sorafenib in Metastatic Papillary and Chromophobe Renal Cell Carcinoma
J. Clin. Oncol., January 1, 2008; 26(1): 127 - 131.
[Abstract] [Full Text] [PDF]

Home page
 Am Soc Clin Oncol Ed BookHome page
W. K. Rathmell, W. M. Stadler, and B. I. Rini
Rational Therapeutic Choices and Strategies for Patients with Metastatic Renal Cancer
ASCO Educational Book, January 1, 2008; 2008(1): 192 - 198.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
J. Zhang, R. A. Lefkowitz, N. M. Ishill, L. Wang, C. S. Moskowitz, P. Russo, H. Eisenberg, and H. Hricak
Solid Renal Cortical Tumors: Differentiation with CT
Radiology, August 1, 2007; 244(2): 494 - 504.
[Abstract] [Full Text] [PDF]

Home page
 Ann OncolHome page
T. Choueiri, B. Rini, J. Garcia, R. Baz, R. Abou-Jawde, S. Thakkar, P Elson, T. Mekhail, M Zhou, and R. Bukowski
Prognostic factors associated with long-term survival in previously untreated metastatic renal cell carcinoma
Ann. Onc., February 1, 2007; 18(2): 249 - 255.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Cancer Res.Home page
J. Jones and T. A. Libermann
Genomics of Renal Cell Cancer: The Biology Behind and the Therapy Ahead
Clin. Cancer Res., January 15, 2007; 13(2): 685s - 692s.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Cancer Res.Home page
D. F. McDermott
Update on the Application of Interleukin-2 in the Treatment of Renal Cell Carcinoma
Clin. Cancer Res., January 15, 2007; 13(2): 716s - 720s.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
M. Parton, M. Gore, and T. Eisen
Role of Cytokine Therapy in 2006 and Beyond for Metastatic Renal Cell Cancer
J. Clin. Oncol., December 10, 2006; 24(35): 5584 - 5592.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
S. E. Eggener, O. Yossepowitch, J. A. Pettus, M. E. Snyder, R. J. Motzer, and P. Russo
Renal Cell Carcinoma Recurrence After Nephrectomy for Localized Disease: Predicting Survival From Time of Recurrence
J. Clin. Oncol., July 1, 2006; 24(19): 3101 - 3106.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
E. A. Ronnen, G. V. Kondagunta, and R. J. Motzer
Medullary Renal Cell Carcinoma and Response to Therapy With Bortezomib
J. Clin. Oncol., March 20, 2006; 24(9): e14 - e14.
[Full Text] [PDF]

Home page
 NEJMHome page
H. T. Cohen and F. J. McGovern
Renal-Cell Carcinoma
N. Engl. J. Med., December 8, 2005; 353(23): 2477 - 2490.
[Full Text] [PDF]

Home page
 Cancer Res.Home page
X. J. Yang, M.-H. Tan, H. L. Kim, J. A. Ditlev, M. W. Betten, C. E. Png, E. J. Kort, K. Futami, K. A. Furge, M. Takahashi, et al.
A Molecular Classification of Papillary Renal Cell Carcinoma
Cancer Res., July 1, 2005; 65(13): 5628 - 5637.
[Abstract] [Full Text] [PDF]

Home page
 J. Mol. Diagn.Home page
A. N. Schuetz, Q. Yin-Goen, M. B. Amin, C. S. Moreno, C. Cohen, C. D. Hornsby, W. L. Yang, J. A. Petros, M. M. Issa, J. G. Pattaras, et al.
Molecular Classification of Renal Tumors by Gene Expression Profiling
J. Mol. Diagn., May 1, 2005; 7(2): 206 - 218.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
J.-J. Patard, E. Leray, N. Rioux-Leclercq, L. Cindolo, V. Ficarra, A. Zisman, A. De La Taille, J. Tostain, W. Artibani, C. C. Abbou, et al.
Prognostic Value of Histologic Subtypes in Renal Cell Carcinoma: A Multicenter Experience
J. Clin. Oncol., April 20, 2005; 23(12): 2763 - 2771.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Cancer Res.Home page
R. J. Motzer, J. Bacik, and M. Mazumdar
Prognostic Factors for Survival of Patients with Stage IV Renal Cell Carcinoma: Memorial Sloan-Kettering Cancer Center Experience
Clin. Cancer Res., September 15, 2004; 10(18): 6302S - 6303S.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Cancer Res.Home page
J. S. Lam, A. S. Belldegrun, and R. A. Figlin
Tissue Array-Based Predictions of Pathobiology, Prognosis, and Response to Treatment for Renal Cell Carcinoma Therapy
Clin. Cancer Res., September 15, 2004; 10(18): 6304S - 6309S.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Cancer Res.Home page
W. M. Stadler
Therapeutic Options for Variant Renal Cancer: A True Orphan Disease
Clin. Cancer Res., September 15, 2004; 10(18): 6393S - 6396S.
[Abstract] [Full Text] [PDF]

Home page
 JCOHome page
R. J. Motzer, J. Bacik, L. H. Schwartz, V. Reuter, P. Russo, S. Marion, and M. Mazumdar
Prognostic Factors for Survival in Previously Treated Patients With Metastatic Renal Cell Carcinoma
J. Clin. Oncol., February 1, 2004; 22(3): 454 - 463.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
S. D. W. Beck, M. I. Patel, M. E. Snyder, M. W. Kattan, R. J. Motzer, V. E. Reuter, and P. Russo
Effect of Papillary and Chromophobe Cell Type on Disease-Free Survival After Nephrectomy for Renal Cell Carcinoma
Ann. Surg. Oncol., January 1, 2004; 11(1): 71 - 77.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Save to my personal folders
Right arrow Download to citation manager
Right arrowRights & Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Motzer, R. J.
Right arrow Articles by Reuter, V.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Motzer, R. J.
Right arrow Articles by Reuter, V.

About
JCO		 Editorial
Roster		 Advertising
Information		 Librarians &
Institutions		 Rights &
Permissions		 PDA Services

Copyright © 2002 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
Terms and Conditions of Use
  HighWire Press HighWire Press™ assists in the publication of JCO Online