IMP3 Expression Predicts Metastatic-free Survival in Patients with High-risk Renal-cell Carcinoma
Lucille Cox, BA; Brittany Berk, BA; Stephanie Bond, BA; Sana Majid, BA; Joanna Wang, BA; Alexander Miller, BA; Tong Sun, MD; Kristine Cornejo, MD; Zhong Jiang, MD; Scott Greenberg, MD; Jennifer K. Yates, MD
University of Massachusetts Medical School, Worcester, MA
BACKGROUND: IMP3 staining is a useful prognostic marker in renal-cell carcinoma (RCC) because it correlates with the development of metastatic disease. The ability to risk-stratify patients with a high risk of tumor recurrence after surgical management is of particular interest given the emergence of effective adjuvant therapies. We sought to determine whether IMP3 expression is a predictor of disease-free survival in a cohort of patients treated surgically for stage III RCC.
METHODS: Of the 294 patients at our institution who underwent either partial or radical nephrectomy for stage I-III RCC between November 2008 and September 2014, a total of 53 patients were identified to have locoregional, high-risk RCC (defined as stage III disease) at the time of surgery. Retrospective reviews of the medical records of these patients were conducted, with follow-up through January 2018. These records were used to determine pertinent information including gender, age, status of disease recurrence, time from surgery to metastasis, mortality, and IMP3 staining status. Overall survival and time-to-metastases analyses were conducted to assess whether IMP3 positivity correlated with the progression of disease in this high-risk subgroup.
RESULTS: 53 patients with stage III RCC at the time of surgery were included in the study. Of these, the renal masses of 21 (39.6%) stained positive for IMP3 and 32 (60.4%) stained negative for IMP3. IMP3 positive staining correlated with reduced metastatic-free survival (p=0.011) on multiple analytical models, but it did not correlate with overall survival (p=0.322).
CONCLUSIONS: Identifying markers of aggressive disease is gaining importance in the era of targeted therapy. Specifically, the use of targeted adjuvant therapy could be useful in high risk IMP3 positive patients due to the increased risk of metastasis. IMP3 status therefore should be included in the risk-stratification of these patients when determining whether adjuvant treatment would be beneficial. Although overall survival did not correlate with IMP3 status in this subgroup of high risk patients, this was likely due to duration of follow-up, the presence of other comorbidities leading to mortality from other causes, and the size of the population. Additional studies can help identify not only which patients may benefit from targeted adjuvant therapy, but may also help guide the choice of therapy.
Back to 2018 Program