Department of Urology, University of Michigan, Ann Arbor, MI, USA.
Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
Eur Urol. 2018 May;73(5):763-769. doi: 10.1016/j.eururo.2017.12.002. Epub 2017 Dec 14.
There is a critical need for improved prognostic discrimination in patients with renal cell carcinoma (RCC) given the increasing awareness that some patients may be managed with active surveillance, while others with higher-risk disease might benefit from adjuvant therapy following surgery.
To determine whether a multigene proliferation signature predicts long-term oncologic outcomes in surgically resected RCC.
DESIGN, SETTING, AND PARTICIPANTS: The cell cycle proliferation (CCP) score was determined after radical nephrectomy for localized clear cell, papillary, or chromophobe RCC in 565 patients.
The primary end point was disease-specific mortality (DSM), and disease recurrence was a secondary end point. Association with outcomes was evaluated by Cox proportional hazards survival analysis. The CCP score was compared with the Karakiewicz nomogram, and a composite (R-CCP) score was developed.
A total of 68 patients (12%) recurred and 32 (6%) died of disease within 5 yr of nephrectomy. The CCP score was an independent predictor of recurrence (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.07-2.09) and DSM (HR 2.49, 95% CI 1.53-4.04) after adjusting for clinical variables using the baseline nomogram. The composite R-CCP score gave a Harrell's concordance index of 0.87 and stratified patients into low- (n=338) and high-risk (n=202) categories with 99% and 84% cancer-specific survival probabilities, respectively (p<0.001).
The CCP score is a significant, independent predictor of long-term oncologic outcomes in patients who have undergone nephrectomy for RCC. Combining the molecular classifier with baseline clinical variables allows for accurate, patient-specific risk assessment for use in guiding clinical management.
In this study, we sought to understand how well gene expression information from individual kidney tumors can predict cancer recurrence and death following surgical removal. We found that the combination of the gene expression test and clinical characteristics provides an accurate prognostic assessment to help inform clinical decisions.
由于人们越来越意识到，某些患者可以通过积极监测进行管理，而某些具有更高风险疾病的患者可能会从手术后的辅助治疗中受益，因此迫切需要改善肾细胞癌（RCC）患者的预后区分。
确定多基因增殖标志物是否可预测接受根治性肾切除术的 RCC 患者的长期肿瘤学结局。
设计、设置和参与者：对 565 例局限性透明细胞、乳头状或嫌色细胞 RCC 患者行根治性肾切除术，测定细胞周期增殖（CCP）评分。
主要终点为疾病特异性死亡率（DSM），疾病复发为次要终点。采用 Cox 比例风险生存分析评估与结局的相关性。将 CCP 评分与 Karakiewicz 列线图进行比较，并开发出复合（R-CCP）评分。
共有 68 例（12%）患者在肾切除术后 5 年内复发（68 例，12%），32 例（6%）死于疾病。CP 评分是复发（危险比[HR]1.50，95%置信区间[CI]1.07-2.09）和 DSM（HR 2.49，95%CI 1.53-4.04）的独立预测因素，调整基线列线图中的临床变量后。复合 R-CCP 评分的 Harrell 一致性指数为 0.87，将患者分为低危（n=338）和高危（n=202）两类，分别有 99%和 84%的癌症特异性生存率（p<0.001）。
CP 评分是接受肾切除术治疗的 RCC 患者长期肿瘤学结局的重要独立预测指标。将分子分类器与基线临床变量相结合，可以进行准确的、针对患者的风险评估，用于指导临床管理。
在这项研究中，我们试图了解来自个体肾肿瘤的基因表达信息在多大程度上可以预测手术后癌症复发和死亡。我们发现，基因表达测试和临床特征的组合提供了准确的预后评估，有助于指导临床决策。
