Application of the Stage, Size, Grade, and Necrosis (SSIGN) Score for Clear Cell Renal Cell Carcinoma in Contemporary Patients

Abstract

Background The tumor stage, size, grade, and necrosis (SSIGN) score was originally defined using patients treated with radical nephrectomy (RN) between 1970 and 1998 for clear cell renal cell carcinoma (ccRCC), excluding patients treated with partial nephrectomy (PN). Objective To characterize the original SSIGN score cohort with longer follow-up and evaluate a contemporary series of patients treated with RN and PN. Design, setting, and participants Retrospective single-institution review of 3600 consecutive surgically treated ccRCC patients grouped into three cohorts: original RN, contemporary (1999–2010) RN, and contemporary PN. Intervention RN or PN. Outcome measurements and statistical analysis The association of the SSIGN score with risk of death from RCC was assessed using a Cox proportional hazards regression model, and predictive ability was summarized with a C-index. Results and limitations The SSIGN scores differed significantly between the original RN, contemporary RN, and contemporary PN cohorts (p < 0.001), with SSIGN ≥4 in 53.5%, 62.7%, and 4.7%, respectively (p < 0.001). The median durations of follow-up for these groups were 20.1, 9.2, and 7.6 yr, respectively. Each increase in the SSIGN score was predictive of death from RCC (hazard ratios [HRs]: 1.41 for original RN, 1.37 for contemporary RN, and 1.70 for contemporary PN; all p < 0.001). The C-indexes for these models were 0.82, 0.84, and 0.82 for original RN, contemporary RN, and contemporary PN, respectively. After accounting for an era-specific improvement in survival among RN patients (HR: 0.53 for contemporary vs original RN; p < 0.001), the SSIGN score remained predictive of death from RCC (HR: 1.40; p < 0.001). Conclusions The SSIGN score remains a useful prediction tool for patients undergoing RN with 20-yr follow-up. When applied to contemporary RN and PN patients, the score retained strong predictive ability. These results should assist in patient counseling and help guide surveillance for ccRCC patients treated with RN or PN. Patient summary We evaluated the validity of a previously described tool to predict survival following surgery in contemporary patients with kidney cancer. We found that this tool remains valid even when extended to patients significantly different than were initially used to create the tool.

Development and validation of a robust multigene signature as an aid to predict early relapse in stage I-III clear cell and papillary renal cell cancer

“…However, early and late relapse after surgery cannot be distinguished by TNM staging system which mainly depends on anatomical information instead of biological characteristics. The large variation in the relapse and prognosis of localized RCC patients with same clinicopathological features is attributed to the biological heterogeneity of cancer [10][11][12] . RCC patients with early relapse suffer from significantly poor OS rates comparing to those with late relapse [18] .…”

“…As reason described above, prognosis even varies significantly in RCC patients with comparable clinicopathological characteristics and same tumor TNM stage. Despite researchers are exploring extensively the potential indicator or biomarker for predicting early relapse in RCC patients [10][11][12] , none of gene-based prognostic classifiers for predicting early relapse of RCC have been established. Although studies in clear cell RCC demonstrated that gene signature has better ability to both reflect heterogeneity of cancer and then accurately predict cancer prognosis [13][14][15] .…”

Contemporary Trends in Adjuvant and Neoadjuvant Treatment for Renal Cell Carcinoma

“…Therefore, patients in this at-risk group can be considered candidates for adjuvant treatment. There is also a striking recent publication recommending the use of the SSIGN classification (28). In fact, it was stated that the calculated SSIGN score can be used to predict recurrence during 20-year follow-up after surgery.…”

Glutamate transporter SLC1A1 is associated with clear cell renal cell carcinoma

“…Often, ccRCC attacks the renal venous system, sometimes filling the renal vein and growing longer into the vena cava or even the right atrium. It is by far the most frequent type of kidney cancer in adults (2).…”