Portal de Periódicos da CAPES

PROGNOSTIC INDICATORS FOR RENAL CELL CARCINOMA: A MULTIVARIATE ANALYSIS OF 643 PATIENTS USING THE REVISED 1997 TNM STAGING CRITERIA

2000; Lippincott Williams & Wilkins; Volume: 163; Issue: 4 Linguagem: Inglês

10.1016/s0022-5347(05)67699-9

1527-3792

Ke‐Hung Tsui, Oleg Shvarts, Robert B. Smith, Robert A. Figlin, Jean B. deKernion, Arie S. Belldegrun,

Bladder and Urothelial Cancer Treatments

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Apr 2000PROGNOSTIC INDICATORS FOR RENAL CELL CARCINOMA: A MULTIVARIATE ANALYSIS OF 643 PATIENTS USING THE REVISED 1997 TNM STAGING CRITERIA KE-HUNG TSUI, OLEG SHVARTS, ROBERT B. SMITH, ROBERT A. FIGLIN, JEAN B. deKERNION, and ARIE BELLDEGRUN KE-HUNG TSUIKE-HUNG TSUI , OLEG SHVARTSOLEG SHVARTS , ROBERT B. SMITHROBERT B. SMITH , ROBERT A. FIGLINROBERT A. FIGLIN , JEAN B. deKERNIONJEAN B. deKERNION , and ARIE BELLDEGRUNARIE BELLDEGRUN View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67699-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determine independent prognostic indicators for renal cell carcinoma using the revised 1997 TNM staging criteria. Materials and Methods: The records of 643 consecutive patients undergoing partial or radical nephrectomy at our institution between 1987 and 1998 were reviewed. Preoperative evaluation of functional status using the Eastern Cooperative Oncology Group (ECOG) criteria was performed in all cases. Renal cell carcinoma grade and stage were evaluated using the 1997 American Joint Committee on Cancer grading and TNM staging criteria, respectively. Patients were followed for a mean plus or minus standard deviation of 47 ± 40 months (median 87). Kaplan-Meier survival curves were used to determine 5-year cancer specific survival for all patient groups. Univariate analysis using log rank sum tests was performed to evaluate the prognostic significance of overall TNM stage, tumor stage, disease grade and ECOG status. Multivariate analysis was performed to determine which factors had an independent impact on survival of patients with renal cell carcinoma. Results: The 5-year cancer specific survival rate was 91%, 74%, 67% and 32% for TNM stages I, II, III and IV lesions, respectively (p <0.001). Analysis demonstrated a survival rate of 83% for stage T1, 57% for stage T2, 42% for stage T3 and 28% for stage T4 disease (p <0.001), and 89% for grade 1, 65% for grade 2, and 46% for grades 3 and 4 (p <0.001). Multivariate analysis revealed that overall TNM stage and grade of disease were the most important prognostic indicators for renal cell carcinoma (p <0.001). ECOG classification was a less significant predictor (p = 0.031) and tumor stage was not shown to have any independent impact on patient survival (p = 0.138). Conclusions: Better survival rates of patients with localized and advanced renal cell carcinoma can be demonstrated with recent advances in diagnosis and treatment. The revised 1997 TNM criteria manifest an appropriate adjustment in staging renal cell carcinoma based on these improvements, with overall stage correlating with cancer specific survival. In contrast, while effectively predicting survival, tumor stage did not demonstrate an independent impact on renal cell carcinoma prognosis under multivariate analysis. Instead, other factors, such as ECOG status and more importantly grade of disease, appeared to affect survival significantly as independent elements. Based on our recent experience with patients treated for renal cell carcinoma in the era of enhanced technology and improved survival, tumor grade and molecular markers may serve as useful adjuncts to TNM staging in guiding treatment and predicting survival outcomes. References 1 : Renal tumors. In: . Philadelphia: W. B. Saunders Co.1998: 2283. chapt. 76. Google Scholar 2 : Diagnosis and management of renal cell carcinoma: a clinical and pathological study of 309 cases. Cancer1971; 28: 1165. Google Scholar 3 : Prognostic factors in renal carcinoma. An evaluation of operative findings. Br J Urol1984; 56: 270. Google Scholar 4 : Prognostic factors in metastatic renal carcinoma. J Urol1986; 136: 376. Link, Google Scholar 5 : Prognostic factors in renal cancer. Urol Clin North Am1993; 20: 247. Crossref, Medline, Google Scholar 6 : Malignant neoplasms of the kidney: an analysis of 353 patients followed five years or more. J Urol1958; 79: 196. Link, Google Scholar 7 : The results of radical nephrectomy for renal cell carcinoma. J Urol1969; 101: 297. Link, Google Scholar 8 : Prognostic indicators in renal adenocarcinoma. J Urol1983; 130: 20. Link, Google Scholar 9 : The value of morphological prognostic criteria in the assessment of renal cell carcinoma. Urol Int1985; 40: 148. Google Scholar 10 : Validation of the tumor, nodes, and metastasis classification of renal cell carcinoma. J Urol1985; 134: 450. Link, Google Scholar 11 : Prognostic significance of nuclear DNA content and proliferative activity in renal cell carcinomas. A clinicopathologic study of 58 patients using mitotic count, MIB-1 staining and DNA cytophotometry. Cancer1996; 77: 514. Google Scholar 12 : Manual for Staging of Cancer. In: . Philadelphia: J.B. Lippincott1992: 201. Google Scholar 13 : Significance of conventional and new prognostic factors for locally confined renal cell carcinoma. Cancer1995; 76: 296. Google Scholar 14 : Value of morphometry as an independent prognostic factor in renal cell carcinoma. Eur Urol1995; 27: 54. Google Scholar 15 : Incidental detection of renal cell carcinoma during radiological imaging. Brit J Urol1987; 59: 513. Google Scholar 16 : Renal cell carcinoma: earlier discovery and increased detection. Radiology1989; 170: 699. Crossref, Medline, Google Scholar 17 : Increased incidental detection and reduced mortality in renal cancer: recent retrospective analysis at 8 institutions. Int J Urol1995; 2: 77. Google Scholar 18 : Efficacy of nephron-sparing surgery for renal cell carcinoma: Analysis based on the new 1997 tumor-node-metastasis staging system. J Clin Oncol1999; 17: 2868. Crossref, Medline, Google Scholar 19 : Treatment of metastatic renal cell carcinoma with nephrectomy, interleukin-2 and cytokine-primed or CD8(+) selected tumor infiltrating lymphocytes from primary tumor. J Urol1997; 158: 740. Link, Google Scholar 20 : Interleukin-2 based immunotherapy for the treatment of metastatic renal cell carcinoma: an analysis of 203 consecutively treated patients. Cancer J Sci Amer1997; 3: S92. Google Scholar 21 : TNM staging of renal cell carcinoma. Workgroup no. 3. Union International Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer1997; 80: 992. Google Scholar 22 : Cancer Statistics, 1998. CA Cancer J Clin1998; 48: 6. Crossref, Medline, Google Scholar 23 : Rising incidence of renal cell cancer in the United States. JAMA1999; 281: 1628. Crossref, Medline, Google Scholar 24 : Significance of the 1997 TNM staging system for pathologic classification of renal cell carcinoma. J Urol1999; 161: 193. abstract 735. Crossref, Medline, Google Scholar 25 : Renal cell carcinoma: long-term survival and late recurrence. J Urol1981; 126: 17. Link, Google Scholar 26 : Analysis of imaging modalities, staging systems, and prognostic indicators for renal cell carcinoma. Urology1992; 39: 122. Google Scholar 27 : Stratification of risk factors in renal cell carcinoma. Cancer1983; 52: 899. Google Scholar 28 : Renal cell carcinoma: Survival and prognostic factors. Urology1986; 27: 291. Google Scholar 29 : The surgical management for renal cell carcinoma: long-term results in a large group of patients. J Urol1998; 159: 192. abstract 737. Google Scholar 30 : Renal cell carcinoma: tumor size, stage, and survival. J Urol1995; 153: 901. Link, Google Scholar 31 : Radical nephrectomy for renal cell carcinoma: long-term results and prognostic factors on a series of 328 cases. Eur Urol1997; 31: 40. Google Scholar 32 : Prognostic factors for survival in patients with metastatic renal cancer treated with biological response modifiers. J Urol1995; 154: 35. Link, Google Scholar 33 : Nephrectomy before interleukin-2 therapy for patients with metastatic renal cell carcinoma. J Urol1997; 158: 1691. Link, Google Scholar 34 : Histopathologic prognostic indicators for renal cell carcinoma. Semin Diagn Pathol1998; 15: 68. Google Scholar 35 : A comparative analysis of grading systems in renal adenocarcinoma. Histopathology1994; 24: 473. Google Scholar 36 : Renal cell carcinoma in New Zealand: a national survival study. Urology1994; 43: 300. Google Scholar 37 : Prognostic value of nuclear grade of renal cell carcinoma. Cancer1995; 76: 2543. Google Scholar 38 : Prognostic factors of renal cell carcinoma: a multivariate analysis. J Surg Oncol1998; 68: 11. Google Scholar 39 : Prognostic value of Ki-67 expression in renal cell carcinomas. Eur Urol1997; 31: 350. Google Scholar 40 : Proliferating cell nuclear antigen (PCNA) as a prognostic factor in renal cell carcinoma. Anticancer Res1998; 18: 677. Google Scholar From the Departments of Urology and Medicine, University of California Los Angeles School of Medicine, Los Angeles, California© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byLenis A, Donin N, Johnson D, Faiena I, Salmasi A, Drakaki A, Belldegrun A, Pantuck A and Chamie K (2017) Adjuvant Therapy for High Risk Localized Kidney Cancer: Emerging Evidence and Future Clinical TrialsJournal of Urology, VOL. 199, NO. 1, (43-52), Online publication date: 1-Jan-2018.Saroha S, Uzzo R, Plimack E, Ruth K and Al-Saleem T (2012) Lymphopenia is an Independent Predictor of Inferior Outcome in Clear Cell Renal CarcinomaJournal of Urology, VOL. 189, NO. 2, (454-461), Online publication date: 1-Feb-2013.Brookman-May S, May M, Zigeuner R, Shariat S, Scherr D, Chromecki T, Moch H, Wild P, Mohamad-Al-Ali B, Cindolo L, Wieland W, Schips L, De Cobelli O, Rocco B, Santoro L, De Nunzio C, Tubaro A, Coman I, Feciche B, Truss M, Dalpiaz O, Hohenfellner M, Gilfrich C, Wirth M, Burger M and Pahernik S (2011) Collecting System Invasion and Fuhrman Grade But Not Tumor Size Facilitate Prognostic Stratification of Patients With pT2 Renal Cell CarcinomaJournal of Urology, VOL. 186, NO. 6, (2175-2181), Online publication date: 1-Dec-2011.Klatte T, Anterasian C, Said J, de Martino M, Kabbinavar F, Belldegrun A and Pantuck A (2010) Fuhrman Grade Provides Higher Prognostic Accuracy Than Nucleolar Grade for Papillary Renal Cell CarcinomaJournal of Urology, VOL. 183, NO. 6, (2143-2147), Online publication date: 1-Jun-2010.Hinz S, Weikert S, Magheli A, Hoffmann M, Engers R, Miller K and Kempkensteffen C (2009) Expression Profile of the Polycomb Group Protein Enhancer of Zeste Homologue 2 and its Prognostic Relevance in Renal Cell CarcinomaJournal of Urology, VOL. 182, NO. 6, (2920-2925), Online publication date: 1-Dec-2009.Jeon H, Jeong I, Kwak C, Kim H, Lee S and Lee E (2009) Reevaluation of Renal Cell Carcinoma and Perirenal Fat Invasion OnlyJournal of Urology, VOL. 182, NO. 5, (2137-2143), Online publication date: 1-Nov-2009.Berger A, Brandina R, Atalla M, Herati A, Kamoi K, Aron M, Haber G, Stein R, Desai M, Kavoussi L and Gill I (2009) Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma: Oncological Outcomes at 10 Years or MoreJournal of Urology, VOL. 182, NO. 5, (2172-2176), Online publication date: 1-Nov-2009.Terrone C, Gontero P, Volpe A, Porpiglia F, Bollito E, Zattoni F, Frea B, Tizzani A, Fontana D, Scarpa R and Rossetti S (2008) Proposal of an Improved Prognostic Classification for pT3 Renal Cell CarcinomaJournal of Urology, VOL. 180, NO. 1, (72-78), Online publication date: 1-Jul-2008.Seligson D, Rajasekaran S, Yu H, Liu X, Eeva M, Tze S, Ball W, Horvath S, deKernion J and Rajasekaran A (2007) Na,K-Adenosine Triphosphatase α1-Subunit Predicts Survival of Renal Clear Cell CarcinomaJournal of Urology, VOL. 179, NO. 1, (338-345), Online publication date: 1-Jan-2008.Margulis V, Tamboli P, Matin S, Meisner M, Swanson D and Wood C (2007) Location of Extrarenal Tumor Extension Does Not Impact Survival of Patients With pT3a Renal Cell CarcinomaJournal of Urology, VOL. 178, NO. 5, (1878-1882), Online publication date: 1-Nov-2007.Dall'Oglio M, Ribeiro-Filho L, Antunes A, Crippa A, Nesrallah L, Gonçalves P, Leite K and Srougi M (2007) Microvascular Tumor Invasion, Tumor Size and Fuhrman Grade: A Pathological Triad for Prognostic Evaluation of Renal Cell CarcinomaJournal of Urology, VOL. 178, NO. 2, (425-428), Online publication date: 1-Aug-2007.Peter C, Kielstein J, Clarke-Katzenberg R, Adams M, Pitsiouni M, Kambham N, Karimi M, Kengatharan K and Cooke J (2018) A Novel Bioluminescent Tumor Model of Human Renal Cancer Cell Lines: An In Vitro and In Vivo CharacterizationJournal of Urology, VOL. 177, NO. 6, (2342-2346), Online publication date: 1-Jun-2007.Novara G, Martignoni G, Artibani W and Ficarra V (2018) Grading Systems in Renal Cell CarcinomaJournal of Urology, VOL. 177, NO. 2, (430-436), Online publication date: 1-Feb-2007.PERMPONGKOSOL S, CHAN D, LINK R, SROKA M, ALLAF M, VARKARAKIS I, LIMA G, JARRETT T and KAVOUSSI L (2018) LONG-TERM SURVIVAL ANALYSIS AFTER LAPAROSCOPIC RADICAL NEPHRECTOMYJournal of Urology, VOL. 174, NO. 4 Part 1, (1222-1225), Online publication date: 1-Oct-2005.LAM J, SHVARTS O, LEPPERT J, FIGLIN R and BELLDEGRUN A (2018) RENAL CELL CARCINOMA 2005: NEW FRONTIERS IN STAGING, PROGNOSTICATION AND TARGETED MOLECULAR THERAPYJournal of Urology, VOL. 173, NO. 6, (1853-1862), Online publication date: 1-Jun-2005.ROBERTS W, BHAYANI S, ALLAF M, CHAN T, KAVOUSSI L and JARRETT T (2018) PATHOLOGICAL STAGE DOES NOT ALTER THE PROGNOSIS FOR RENAL LESIONS DETERMINED TO BE STAGE T1 BY COMPUTERIZED TOMOGRAPHYJournal of Urology, VOL. 173, NO. 3, (713-715), Online publication date: 1-Mar-2005.SHVARTS O, SELIGSON D, LAM J, SHI T, HORVATH S, FIGLIN R, BELLDEGRUN A and PANTUCK A (2018) p53 IS AN INDEPENDENT PREDICTOR OF TUMOR RECURRENCE AND PROGRESSION AFTER NEPHRECTOMY IN PATIENTS WITH LOCALIZED RENAL CELL CARCINOMAJournal of Urology, VOL. 173, NO. 3, (725-728), Online publication date: 1-Mar-2005.FRANK I, BLUTE M, LEIBOVICH B, CHEVILLE J, LOHSE C, KWON E and ZINCKE H (2018) pT2 CLASSIFICATION FOR RENAL CELL CARCINOMA. CAN ITS ACCURACY BE IMPROVED?Journal of Urology, VOL. 173, NO. 2, (380-384), Online publication date: 1-Feb-2005.PATARD J, LERAY E, CINDOLO L, FICARRA V, RODRIGUEZ A, DE LA TAILLE A, TOSTAIN J, ARTIBANI W, ABBOU C, GUILLÉ F, CHOPIN D and LOBEL B (2018) MULTI-INSTITUTIONAL VALIDATION OF A SYMPTOM BASED CLASSIFICATION FOR RENAL CELL CARCINOMAJournal of Urology, VOL. 172, NO. 3, (858-862), Online publication date: 1-Sep-2004.SÁNCHEZ-ORTIZ R, ROSSER C, MADSEN L, SWANSON D and WOOD C (2018) YOUNG AGE IS AN INDEPENDENT PROGNOSTIC FACTOR FOR SURVIVAL OF SPORADIC RENAL CELL CARCINOMAJournal of Urology, VOL. 171, NO. 6 Part 1, (2160-2165), Online publication date: 1-Jun-2004.PALAPATTU G, PANTUCK A, DOREY F, SAID J, FIGLIN R and BELLDEGRUN A (2018) Collecting System Invasion In Renal Cell Carcinoma: Impact on Prognosis And Future Staging StrategiesJournal of Urology, VOL. 170, NO. 3, (768-772), Online publication date: 1-Sep-2003.ASHIDA S, FURIHATA M, TANIMURA M, SUGITA O, YAMASHITA M, MIURA T, MORIYAMA M and SHUIN T (2018) Molecular Detection of Von Hippel-Lindau Gene Mutations in Urine and Lymph Node Samples in Patients with Renal Cell Carcinoma: Potential Biomarkers for Early Diagnosis and Postoperative Metastatic StatusJournal of Urology, VOL. 169, NO. 6, (2089-2093), Online publication date: 1-Jun-2003.FRANK I, BLUTE M, CHEVILLE J, LOHSE C, WEAVER A and ZINCKE H (2018) An Outcome Prediction Model for Patients with Clear Cell Renal Cell Carcinoma Treated with Radical Nephrectomy Based on Tumor Stage, Size, Grade and Necrosis: The Ssign ScoreJournal of Urology, VOL. 168, NO. 6, (2395-2400), Online publication date: 1-Dec-2002.Ward J, Blute M, Cheville J, Lohse C, Weaver A and Zincke H (2018) The Influence of Pnx/Pn0 Grouping in a Multivariate Setting for Outcome Modeling in Patients with Clear Cell Renal Cell CarcinomaJournal of Urology, VOL. 168, NO. 1, (56-60), Online publication date: 1-Jul-2002.PORTIS A, YAN Y, LANDMAN J, CHEN C, BARRETT P, FENTIE D, ONO Y, McDOUGALL E and CLAYMAN R (2018) LONG-TERM FOLLOWUP AFTER LAPAROSCOPIC RADICAL NEPHRECTOMYJournal of Urology, VOL. 167, NO. 3, (1257-1262), Online publication date: 1-Mar-2002.CHAO D, ZISMAN A, PANTUCK A, GITLITZ B, FREEDLAND S, SAID J, FIGLIN R and BELLDEGRUN A (2018) COLLECTING DUCT RENAL CELL CARCINOMA: CLINICAL STUDY OF A RARE TUMORJournal of Urology, VOL. 167, NO. 1, (71-74), Online publication date: 1-Jan-2002.PANTUCK A, ZISMAN A and BELLDEGRUN A (2018) THE CHANGING NATURAL HISTORY OF RENAL CELL CARCINOMAJournal of Urology, VOL. 166, NO. 5, (1611-1623), Online publication date: 1-Nov-2001.ZISMAN A, PANTUCK A, CHAO D, DOREY F, SAID J, GITLITZ B, deKERNION J, FIGLIN R and BELLDEGRUN A (2018) REEVALUATION OF THE 1997 TNM CLASSIFICATION FOR RENAL CELL CARCINOMA: T1 AND T2 CUTOFF POINT AT 4.5 RATHER THAN 7 CM. BETTER CORRELATES WITH CLINICAL OUTCOMEJournal of Urology, VOL. 166, NO. 1, (54-58), Online publication date: 1-Jul-2001. Volume 163Issue 4April 2000Page: 1090-1095 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordsneoplasm stagingkidneyprognosismultivariate analysiscarcinoma, renal cellMetricsAuthor Information KE-HUNG TSUI More articles by this author OLEG SHVARTS More articles by this author ROBERT B. SMITH More articles by this author ROBERT A. FIGLIN More articles by this author JEAN B. deKERNION More articles by this author ARIE BELLDEGRUN More articles by this author Expand All Advertisement PDF downloadLoading ...