Use of the University of California Los Angeles Integrated Staging System to Predict Survival in Renal Cell Carcinoma: An International Multicenter Study

Patard, Jean Jacques; Kim, Hyung L.; Lam, John S.; Dorey, Frederick J.; Pantuck, Allan J.; Zisman, Amnon; Ficarra, Vincenzo; Han, Kyung Joon; Cindolo, Luca; Taille, Alexandre de la; Tostain, Jacques; Artibani, Walter; Dinney, Colin P.N.; Wood, Christopher G.; Swanson, David A.; Abbou, Claude C.; Lobel, Bernard; Mulders, Peter F.A.; Chopin, Dominique; Figlin, Robert A.; Belldegrun, Arie S.

doi:10.1200/jco.2004.09.104

“…Despite validation, none of the proposed models or nomograms is 100% accurate, with C-indices ranging from 74% to 82.2% for assessment of recurrence and from 68% to 89% for assessment of cancer-specific mortality [76]. A commonly used model is the UISS integrated staging system using TNM stage, Eastern Cooperative Oncology Group PS, and nuclear grade [46,77]. The SSIGN score adds necrosis and tumour size and has been modified by Leibovich [44,45].…”

Section: Local Therapy Of Metastases In Rccmentioning

confidence: 99%

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

Ljungberg¹,

Bensalah²,

Canfield³

et al. 2015

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Context: The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. Objectives: To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. Evidence acquisition: For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Evidence synthesis: All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

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“…However, the prognostic information provided by RCC subtype is lost when stratified to tumour stage (LE 3) [43]. For localised RCC, several risk scores and nomograms can be used, including the Stage, Size, Grade, and Necrosis Score (SSIGN) [44], a modified version of the SSIGN score (Leibovich score) [45], the University of California Los Angeles Integrated Staging System (UISS) [46], and Karakiewicz's nomogram (LE 3) [47]; Section 3.7 provides further details. Clinical factors include patient PS, localised symptoms, cachexia, anaemia, elevated neutrophil and platelet counts, and other laboratory parameters, and are predominantly used in prognostic risk models in mRCC (LE 3) [48,49].…”

Section: Prognostic Factorsmentioning

confidence: 99%

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

Ljungberg¹,

Cowan²,

Hanbury³

et al. 2010

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Context: The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. Objectives: To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. Evidence acquisition: For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Evidence synthesis: All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

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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

Raj

¹

,

Thompson

²

,

Leibovich

³

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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Use of the University of California Los Angeles Integrated Staging System to Predict Survival in Renal Cell Carcinoma: An International Multicenter Study

Cited by 353 publications

References 16 publications

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

Preoperative Nomogram Predicting 12-Year Probability of Metastatic Renal Cancer

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