TY - JOUR
T1 - Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma
T2 - Development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN Project)
AU - Brookman-May, Sabine
AU - May, Matthias
AU - Shariat, Shahrokh F.
AU - Xylinas, Evanguelos
AU - Stief, Christian
AU - Zigeuner, Richard
AU - Chromecki, Thomas
AU - Burger, Maximilian
AU - Wieland, Wolf F.
AU - Cindolo, Luca
AU - Schips, Luigi
AU - De Cobelli, Ottavio
AU - Rocco, Bernardo
AU - De Nunzio, Cosimo
AU - Feciche, Bogdan
AU - Truss, Michael
AU - Gilfrich, Christian
AU - Pahernik, Sascha
AU - Hohenfellner, Markus
AU - Zastrow, Stefan
AU - Wirth, Manfred P.
AU - Novara, Giacomo
AU - Carini, Marco
AU - Minervini, Andrea
AU - Simeone, Claudio
AU - Antonelli, Alessandro
AU - Mirone, Vincenzo
AU - Longo, Nicola
AU - Simonato, Alchiede
AU - Carmignani, Giorgio
AU - Ficarra, Vincenzo
PY - 2013/9
Y1 - 2013/9
N2 - Background: Approximately 10-20% of recurrences in patients treated with nephrectomy for renal cell carcinoma (RCC) develop beyond 5 yr after surgery (late recurrence). Objective: To determine features associated with late recurrence. Design, setting, and participants: A total of 5009 patients from a multicenter database comprising 13 107 RCC patients treated surgically had a minimum recurrence-free survival of 60 mo (median follow-up [FU]: 105 mo [range: 78-135]); at last FU, 4699 were disease free (median FU: 103 mo [range: 78-134]), and 310 patients (6.2%) experienced disease recurrence (median FU: 120 mo [range: 93-149]). Interventions: Patients underwent radical nephrectomy or nephron-sparing surgery. Outcome measurements and statistical analysis: Multivariable regression analyses identified features associated with late recurrence. Cox regression analyses evaluated the association of features with cancer-specific mortality (CSM). Results and limitations: Lymphovascular invasion (LVI) (odds ratio [OR]: 3.07; p <0.001), Fuhrman grade 3-4 (OR: 1.60; p = 0.001), and pT stage >pT1 (OR: 2.28; p <0.001) were significantly associated with late recurrence. Based on accordant regression coefficients, these parameters were weighted with point values (LVI: 2 points; Fuhrman grade 3-4: 1 point, pT stage >1: 2 points), and a risk score was developed for the prediction of late recurrences. The calculated values (0 points: Late recurrence risk 3.1%; 1-3 points: 8.4%; 4-5 points: 22.1%) resulted in a good-, intermediate- and poor-prognosis group (area under the curve value for the model: 70%; 95% confidence interval, 67-73). Multivariable Cox regression analysis showed LVI (HR: 2.75; p <0.001), pT stage (HR: 1.24; p <0.001), Fuhrman grade (HR: 2.40; p <0.001), age (HR: 1.01; p <0.001), and gender (HR: 0.71; p = 0.027) to influence CSM significantly. Limitations are based on the multicenter and retrospective study design. Conclusions: LVI, Fuhrman grade 3/4, and a tumor stage >pT1 are independent predictors of late recurrence after at least 5 yr from surgery in patients with RCC. We developed a risk score that allows for prognostic stratification and individualized aftercare of patients with regard to counseling, follow-up scheduling, and clinical trial design.
AB - Background: Approximately 10-20% of recurrences in patients treated with nephrectomy for renal cell carcinoma (RCC) develop beyond 5 yr after surgery (late recurrence). Objective: To determine features associated with late recurrence. Design, setting, and participants: A total of 5009 patients from a multicenter database comprising 13 107 RCC patients treated surgically had a minimum recurrence-free survival of 60 mo (median follow-up [FU]: 105 mo [range: 78-135]); at last FU, 4699 were disease free (median FU: 103 mo [range: 78-134]), and 310 patients (6.2%) experienced disease recurrence (median FU: 120 mo [range: 93-149]). Interventions: Patients underwent radical nephrectomy or nephron-sparing surgery. Outcome measurements and statistical analysis: Multivariable regression analyses identified features associated with late recurrence. Cox regression analyses evaluated the association of features with cancer-specific mortality (CSM). Results and limitations: Lymphovascular invasion (LVI) (odds ratio [OR]: 3.07; p <0.001), Fuhrman grade 3-4 (OR: 1.60; p = 0.001), and pT stage >pT1 (OR: 2.28; p <0.001) were significantly associated with late recurrence. Based on accordant regression coefficients, these parameters were weighted with point values (LVI: 2 points; Fuhrman grade 3-4: 1 point, pT stage >1: 2 points), and a risk score was developed for the prediction of late recurrences. The calculated values (0 points: Late recurrence risk 3.1%; 1-3 points: 8.4%; 4-5 points: 22.1%) resulted in a good-, intermediate- and poor-prognosis group (area under the curve value for the model: 70%; 95% confidence interval, 67-73). Multivariable Cox regression analysis showed LVI (HR: 2.75; p <0.001), pT stage (HR: 1.24; p <0.001), Fuhrman grade (HR: 2.40; p <0.001), age (HR: 1.01; p <0.001), and gender (HR: 0.71; p = 0.027) to influence CSM significantly. Limitations are based on the multicenter and retrospective study design. Conclusions: LVI, Fuhrman grade 3/4, and a tumor stage >pT1 are independent predictors of late recurrence after at least 5 yr from surgery in patients with RCC. We developed a risk score that allows for prognostic stratification and individualized aftercare of patients with regard to counseling, follow-up scheduling, and clinical trial design.
KW - Cancer-specific mortality
KW - Late recurrence
KW - Nephrectomy
KW - Prognostic parameters
KW - Renal cell carcinoma
KW - Risk score
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U2 - 10.1016/j.eururo.2012.06.030
DO - 10.1016/j.eururo.2012.06.030
M3 - Article
C2 - 22748912
AN - SCOPUS:84881126352
VL - 64
SP - 472
EP - 477
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 3
ER -