Histopathological Spectrum of Renal Cell Carcinoma and Its Correlation With Clinical Presentation, Imaging Findings, and Surgical Outcomes: A Multicenter Retrospective Observational Study
Abstract
Introduction:To evaluate the histopathological spectrum of renal cell carcinoma (RCC) and correlate histopathological subtypes and tumor characteristics with clinical presentation, imaging findings, pathological stage, and surgical outcomes. Methods:This multicenter retrospective observational study included 120 adults with histopathologically confirmed RCC who underwent radical or partial nephrectomy at Jagannath Medical College & Hospital, Puri, and Acharya Harihara Post Graduate Institute of Cancer, Cuttack. Clinical, radiological, operative, and histopathological records were reviewed. Histopathological assessment included tumor subtype, WHO/ISUP grade, pathological stage, and lymphovascular invasion. Associations with clinical, imaging, and postoperative variables were assessed using appropriate statistical tests. Results:Clear cell RCC was the predominant subtype (82, 68.3%), followed by papillary RCC (20, 16.7%) and chromophobe RCC (12, 10.0%). Hematuria (51.7%) and flank pain (45.0%) were the most common presentations, while 31.7% of tumors were detected incidentally. Tumor size >7 cm was significantly associated with advanced pathological stage, renal vein invasion, perinephric fat invasion, and enlarged lymph nodes (p<0.05). High WHO/ISUP grade was significantly associated with advanced pathological stage (p<0.001). Postoperative complications occurred in 15.0% of patients and were associated with larger tumor size, high grade, advanced stage, and renal vein invasion. Multivariate analysis identified tumor size >7 cm, high WHO/ISUP grade, stage III–IV disease, and renal vein invasion as significant predictors of postoperative complications. Conclusion:Clear cell RCC predominated, while tumor size, grade, stage, and vascular invasion were significantly associated with disease extent and postoperative outcomes. Recommendation:Integrated clinicoradiological and histopathological assessment should be considered for risk stratification and perioperative management of RCC.