Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma

Abstract

BACKGROUNDThe objective of the current study was to develop an algorithm to predict progression to metastases after radical nephrectomy for patients with clinically localized renal cell carcinoma (RCC) to allow stratification of patients for potential adjuvant therapy trials.METHODSThe authors identified 1671 sporadic patients with clinically localized, unilateral clear cell RCC who underwent radical nephrectomy between 1970 and 2000. The clinical features examined included age, gender, smoking history, recent onset hypertension, performance status, and presenting symptoms. The pathologic features examined included surgical margins, tumor stage, regional lymph node status, tumor size, nuclear grade, histologic tumor necrosis, sarcomatoid component, cystic architecture, and multifocality. Metastases free survival was estimated using the Kaplan–Meier method. A multivariate Cox proportional hazards regression model was fit to determine associations between the clinical and pathologic features and distant metastases.RESULTSThe median follow‐up was 5.4 years (range, 0–31 years). Metastases occurred in 479 patients at a median of 1.3 years (range, 0–25 years) after nephrectomy. The estimated metastases free survival rates were 86.9% at 1 year, 77.8% at 3 years, 74.1% at 5 years, 70.8% at 7 years, and 67.1% at 10 years. Multivariate analysis showed that the following features were associated with progression to metastases: tumor stage, regional lymph node status, tumor size, nuclear grade, and histologic tumor necrosis (P < 0.001 for all).CONCLUSIONSIn patients with clear cell RCC, tumor stage, regional lymph node status, tumor size, nuclear grade, and histologic tumor necrosis showed statistically significant associations with progression to metastatic RCC. The authors present a scoring algorithm based on these features that can be used to predict disease progression after patients undergo radical nephrectomy for clinically localized clear cell RCC. Cancer 2003;97:1663–71. © 2003 American Cancer Society.DOI 10.1002/cncr.11234

Clear Cell Renal Cell Carcinoma: Gene Expression Analyses Identify a Potential Signature for Tumor Aggressiveness

“…One of these models, the SSIGN score, uses pathologic features predictive of cancer-specific survival in CCRCC: tumor size, tumor-node-metastasis (TNM) stage, nuclear grade, and tumor necrosis (13). The second model uses the same pathologic features, except the outcome assessed is metastasis-free survival and not cancer-specific survival (14). The pathologic features required for these models are obtained from the nephrectomy No pT1a pNx pM0 55 ANED NAG P 99 99 NAG-2 3.6 2 No pTa pNx pM0 52 ANED NAG N, P 99 99 NAG-3 3.5 2 No pT1a pNx pM0 41 ANED NAG N, P 99 99 NAG-4 2.8 2 No pT1a pNx pM0 45 ANED NAG P 99 99 NAG-5 5.8 2 No pT1b pNx pM0 36 ANED NAG P 95 95 NAG-6 4.5 2 No pT1b pNx pM0 36 ANED NAG P 99 99 NAG-7 7 2 No pT1b pN0 pM0 36 ANED NAG P 95 95 NAG-8 3 1 No pT1a pNx pM0 11 ANED NAG N, P 99 99 NAG-9 7 1 No pT1b pNx pM0 12 ANED NAG N, P 95 …”

Post Partial Nephrectomy Surveillance Imaging: an Evidence-Based Approach

“…Leibovich and colleagues [20] from the Mayo Clinic developed an alternative algorithm to predict progression to metastatic RCC in patients with clinically localized clear cell RCC after RN (at 1, 3, 5, 7, and 10 years). The features in this model included pT and pN stage (2002 AJCC), tumor size (<10 vs. ≥10 cm), nuclear grade, and the presence of tumor necrosis.…”

Comparison of 18F-FDG PET/CT and ceCT Results in the Assessment of RCC Recurrence

“…The rate of metastasis at diagnosis 20-30% and solitary metastasis is found in 5% of the patients [2,3]. Metastasis is a strong predictor of bad prognosis [4], 5 years survival rates are reported as less than 10% [5,6]. Early detection and management of metastatic disease is crucial to improve prognosis and quality of life.…”