Improved Prognostication of Renal Cell Carcinoma Using an Integrated Staging System

Zisman, Amnon; Pantuck, Allan J.; Fj, Dorey; Said, Jonathan; Shvarts, Oleg; Quintana, Deanna; Gitlitz, Barbara J.; deKernion, Jean B.; Figlin, Robert A.; Belldegrun, Arie S.

doi:10.1200/jco.2001.19.6.1649

Cited by 650 publications

(362 citation statements)

References 19 publications

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“…Distribution of prognostic factors according to Memorial Sloan Kettering Cancer Center (MSKCC) (Motzer et al, 1999) and UCLA Integrated Staging System (Zisman et al, 2001) are given in Table 2a and b.…”

Section: Patients and Samplesmentioning

confidence: 99%

In vivo assessment of the antiproliferative properties of interferon-alpha during immunotherapy: Ki-67 (MIB-1) in patients with metastatic renal cell carcinoma

et al. 2004

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The aim of the present study was to investigate the in vivo antiproliferative effect of interferon alpha (IFN-a) in patients with metastatic renal cell carcinoma (mRCC). Core needle biopsies of metastatic and/or the primary kidney cancer were obtained before interleukin-2 (IL-2)-and IFN-a-based immunotherapy in 34 patients and repeated after 5 weeks in 25 patients. Tumour proliferation was assessed by use of the anti-Ki-67 antibody MIB-1 and evaluated in multiple, random systematic sampled fields of vision. Ki-67 labelling index (LI) at baseline was median 13.6% (range 1.2 -85.0) and median 10.6% (range 1.3 -48.6%) at week 5 with a median overall decline of 15.2% (range À95 to þ 258%) from baseline to week 5. There was no difference between responding and nonresponding patients. Ki-67 LI at week 5 was significantly correlated to survival. Thus, median survival of patients with Ki-67 LI p10.6% at week 5 was 25.1 months compared to 11.5 months for patients with Ki-67 LI 410.6% (P ¼ 0.016). Baseline or change in Ki-67 LI did not correlate to survival. These data suggest that IFN-a in vivo has only modest effect on tumour proliferation in patients with mRCC. Tumour Ki-67 (MIB-1) reactivity after 1 month of immunotherapy appears to be a significant predictor of patient survival.

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Section: Patients and Samplesmentioning

confidence: 99%

In vivo assessment of the antiproliferative properties of interferon-alpha during immunotherapy: Ki-67 (MIB-1) in patients with metastatic renal cell carcinoma

et al. 2004

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“…Post-operative predictive models including the MSKCC post-operative prognostic nomogram, the Mayo clinic SSIGN score and UCLA UISS score were created using clinical stage, tumor histology, pathologic tumor size, pathologic stage and grade, pathologic necrosis, ECOG performance score and symptomatic presentation to predict the freedom from disease recurrence or overall survival after definitive therapy. [8][9][10][11][12][13] Since the various post-operative predictive tools are based on pathologic variables, their utility in the pre-operative setting is limited. A pre-operative tool that predicts the likelihood of metastatic disease following definitive surgical therapy would be useful to risk-stratify patients prior to surgery.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Nomogram Predicting 12-Year Probability of Metastatic Renal Cancer

et al. 2008

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Purpose-For patients with renal masses localized to the kidney, there is currently no preoperative tool to predict the likelihood of metastatic recurrence following surgical intervention. The primary goal of this study was to develop a predictive model that could be used in the preoperative setting.Methods-We pooled institutional databases from Memorial Sloan-Kettering and Mayo Clinic and identified 2,517 patients with renal masses and no concurrent evidence of metatases, who underwent radical or partial nephrectomy and with complete data. Cox proportional hazard regression analyses were used to model pre-operative clinical and radiographic characteristics as predictors for development of metastases following nephrectomy. Internal validation was performed with a statistical bootstrapping technique.Results-Metastatic recurrence developed in 340 of the 2517 patients. Median follow-up for patients without metastatic recurrence was 4.7 years. A nomogram was developed using preoperative characteristics to predict the 12-year likelihood of post-operative metastatic recurrence, with a concordance index (CI) of 0.80. In contrast, the concordance index of pre-operative TNM staging was 0.71. Size of the primary renal mass, evidence of lymphadenopathy or necrosis on pre-operative imaging and the mode of presentation were important predictors for the subsequent development of metastases.Conclusions-We present a pre-operative nomogram that accurately predicts the development of metastatic recurrence following nephrectomy. This nomogram may be potentially useful to identify high-risk patients for clinical trials in neoadjuvant setting.

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“…We relied on two modified FG schemes. The modified two-tiered FG scheme was described by Zisman et al 14 and consisted of grouping FG 1 and 2, as well of grouping FG 3 and 4. The modified three-tiered FG system was described by Ficarra et al 13 It consisted of grouping FG 1 and 2 and keeping FG 3 and 4 unchanged.…”

Section: Description Of Variablesmentioning

confidence: 99%

“…Specifically, we tested and quantified the added value of FG relative to other established prognostic factors. Additionally, we also compared the gains in discriminant accuracy related to the use of the conventional four-tiered FG scheme relative to a modified three- 13 and two-tiered 14 FG schemes.…”

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confidence: 99%

FG has no added value in prediction of mortality after partial and radical nephrectomy for chromophobe renal cell carcinoma patients

et al. 2013

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Our objective was to test whether FG (FG) is applicable in the context of chromophobe renal cell carcinoma patients treated with partial and radical nephrectomy. Patients (n ¼ 1862) with chromophobe renal cell carcinoma treated with partial and radical nephrectomy were identified within the Surveillance, Epidemiology, and End Results (1988-2008). Univariable and multivariable Cox regression analyses were fitted to predict cancer-specific mortality. Discriminant properties were assessed for the conventional four-tiered FG scheme. Additionally, discrimination of the three-tiered FG scheme (1-2 vs 3 vs 4) and the two-tiered FG scheme (1-2 vs 3-4) was also assessed. The statistical significance of the differences in accuracy estimates was compared using the Mantel-Haenszel test. A total of 65 of the 1862 died of the disease. The overall 5-year cancer-specific mortality-free survival rate was 94.8% (95% confidence interval: 93.5-96.2). In univariable analyses, none of the FG strata were significantly associated with cancer-specific mortality. Furthermore, FG was less informative (63%) than tumor size (72%) and tumor stage (69%), using measures of discrimination in univariable analyses. After accounting for all covariates, prediction of 5-year cancer-specific mortality was 79.0% vs 80.3% accurate, respectively, with vs without the consideration of FG (P ¼ 0.01). Similar discrimination estimates were obtained for the modified three-tiered FG scheme (78.5%; P ¼ 0.009) and the modified two-tiered FG scheme (79.5%; P ¼ 0.02). In conclusion, FG is not an informative predictor of prognosis, defined as cancer-specific mortality, after partial and radical nephrectomy for chromophobe renal cell carcinoma patients. Keywords: chromophobe; FG; prognostic factor; renal cell carcinoma FG (FG) represents an important prognostic factor in patients with renal cell carcinoma. 1 It relies on nuclear size, shape, and prominence of nucleoli. 1 To date, 11 studies tested the ability of FG in prediction of prognosis in chromophobe renal cell carcinoma. 2-12 Seven of those failed to confirm the value of FG. 2-8 However, all relied on small sample sizes (n ¼ 49-291), thus power may have been insufficient. [2][3][4][5][6][7][8] Conversely, four other reported the opposite findings. 9-12 Here, FG was found to accurately predict prognosis and study populations included patients with chromophobe renal cell carcinoma. [9][10][11][12] Based on this lack of consensus, we decided to examine the discriminant accuracy of FG in prediction of cancer-specific mortality after partial or radical nephrectomy for chromophobe renal cell carcinoma patients. Specifically, we tested and quantified the added value of FG relative to other established prognostic factors. Additionally, we also compared the gains in discriminant accuracy related to the use of the conventional four-tiered FG scheme relative to a modified three-13 and two-tiered 14 FG schemes.

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Improved Prognostication of Renal Cell Carcinoma Using an Integrated Staging System

Cited by 650 publications

References 19 publications

In vivo assessment of the antiproliferative properties of interferon-alpha during immunotherapy: Ki-67 (MIB-1) in patients with metastatic renal cell carcinoma

In vivo assessment of the antiproliferative properties of interferon-alpha during immunotherapy: Ki-67 (MIB-1) in patients with metastatic renal cell carcinoma

Preoperative Nomogram Predicting 12-Year Probability of Metastatic Renal Cancer

FG has no added value in prediction of mortality after partial and radical nephrectomy for chromophobe renal cell carcinoma patients

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