Patard Jean-Jacques, Leray Emmanuelle, Cindolo Luca, Ficarra Vincenzo, Rodriguez Alejandro, De La Taille Alexandre, Tostain Jacques, Artibani Walter, Abbou Clement C, Guillé François, Chopin Dominique K, Lobel Bernard
Department of Urology, Rennes University Hospital, CHU Pontchaillou, rue Henri Le Guilloux, 35033 Rennes, France.
J Urol. 2004 Sep;172(3):858-62. doi: 10.1097/01.ju.0000135837.64840.55.
We validate the prognostic value of a symptom based classification (S classification) in a multi-institutional study.
A total of 2,242 patients from 5 European centers were included in this study. Based on symptoms at diagnosis, patients were stratified into 3 groups of S1-asymptomatic tumors, S2-tumors with local symptoms and S3-tumors with systemic symptoms. Variables such as age, gender, tumor size, TNM stage, Fuhrman grade, Eastern Cooperative Oncology Group (ECOG) performance status, perinephric fat, renal vein and adrenal invasion were also considered for prognostic value. The end point of the study was cancer specific survival. Survival assessment was made with univariate and multivariate analyses using the Kaplan-Meier method and Cox regression analysis.
Of the patients 1,018 (45.4%) were classified as S1, 865 (38.6%) S2 and 339 (16.0%) S3. The S classification correlated to tumor stage, grade and ECOG (p <0.001). On univariate analysis ECOG performance status, S classification, tumor size, TNM stage, Fuhrman grade, and adrenal, perinephric fat or vein invasion were significant prognostic factors (p <0.001). The S classification provided a significant prognostic stratification in the aggregate as well at each of the 5 centers. On multivariate analysis the S classification, TNM stage, Fuhrman grade, and perinephric fat and renal vein invasion remained independent prognostic factors (p <0.001).
This study confirms that it is possible to graduate symptoms for a prognostic purpose. The proposed symptom score should be evaluated for its integration in prognostic algorithms.
在一项多机构研究中验证基于症状的分类（S分类）的预后价值。
本研究纳入了来自5个欧洲中心的2242例患者。根据诊断时的症状，患者被分为3组：S1-无症状肿瘤组、S2-有局部症状肿瘤组和S3-有全身症状肿瘤组。还考虑了年龄、性别、肿瘤大小、TNM分期、福尔曼分级、东部肿瘤协作组（ECOG）体能状态、肾周脂肪、肾静脉和肾上腺侵犯等变量的预后价值。研究的终点是癌症特异性生存。使用Kaplan-Meier方法和Cox回归分析进行单变量和多变量分析以评估生存情况。
患者中，1018例（45.4%）被分类为S1，865例（38.6%）为S2，339例（16.0%）为S3。S分类与肿瘤分期、分级和ECOG相关（p<0.001）。单变量分析显示，ECOG体能状态、S分类、肿瘤大小、TNM分期、福尔曼分级以及肾上腺、肾周脂肪或静脉侵犯是显著的预后因素（p<0.001）。S分类在总体以及5个中心中的每一个中心都提供了显著的预后分层。多变量分析显示，S分类、TNM分期、福尔曼分级以及肾周脂肪和肾静脉侵犯仍然是独立的预后因素（p<0.001）。
本研究证实了为预后目的对症状进行分级是可行的。所提出的症状评分应评估其在预后算法中的整合情况。
