Meagher Margaret F, Mir Maria C, Minervini Andrea, Kriegmair Maximilian, Heck Matthias, Porpiglia Francesco, Van Bruwaene Siska, Linares Estefania, Hevia Vital, D'Anna Maurizio, Veccia Alessandro, Roussel Eduard, Claps Francesco, Palumbo Carlotta, Marchioni Michele, Afari Jonathan, Saitta Cesare, Liu Franklin, Rubio Jose, Campi Riccardo, Mari Andrea, Amiel Thomas, Checcucci Enrico, Musquera Mireia, Guruli Georgi, Pavan Nicola, Albersen Maarten, Antonelli Alessandro, Klatte Tobias, Autorino Riccardo, McKay Rana R, Derweesh Ithaar H
Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States.
Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain.
Front Oncol. 2023 Mar 29;13:1113246. doi: 10.3389/fonc.2023.1113246. eCollection 2023.
We hypothesized that two-tier re-classification of the "M" (metastasis) domain of the Tumor-Node-Metastasis (TNM) staging of Renal Cell Carcinoma (RCC) may improve staging accuracy than the current monolithic classification, as advancements in the understanding of tumor biology have led to increased recognition of the heterogeneous potential of metastatic RCC (mRCC).
Multicenter retrospective analysis of patients from the REMARCC (REgistry of MetAstatic RCC) database. Patients were stratified by number of metastases into two groups, M1 (≤3, "Oligometastatic") and M2 (>3, "Polymetastatic"). Primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS). Cox-regression and Kaplan-Meier (KMA) analysis were utilized for outcomes, and receiver operating characteristic analysis (ROC) was utilized to assess diagnostic accuracy compared to current "M" staging.
429 patients were stratified into proposed M1 and M2 groups (M1 = 286/M2 = 143; median follow-up 19.2 months). Cox-regression revealed M2 classification as an independent risk factor for worsened all-cause mortality (HR=1.67, p=0.001) and cancer-specific mortality (HR=1.74, p<0.001). Comparing M1-oligometastatic vs. M2-polymetastatic groups, KMA revealed significantly higher 5-year OS (36% vs. 21%, p<0.001) and 5-year CSS (39% vs. 17%, p<0.001). ROC analyses comparing OS and CSS, for M1/M2 reclassification versus unitary M designation currently in use demonstrated improved c-index for OS (M1/M2 0.635 vs. unitary M 0.500) and CSS (M1/M2 0.627 vs. unitary M 0.500).
Subclassification of Stage "M" domain of mRCC into two clinical substage categories based on metastatic burden corresponds to distinctive tumor groups whose oncological potential varies significantly and result in improved predictive capability compared to current staging.
我们假设，对肾细胞癌（RCC）的肿瘤-淋巴结-转移（TNM）分期中的“M”（转移）域进行两级重新分类，可能比当前的单一分类提高分期准确性，因为对肿瘤生物学理解的进展导致对转移性肾细胞癌（mRCC）异质性潜能的认识增加。
对来自REMARCC（转移性RCC登记处）数据库的患者进行多中心回顾性分析。患者按转移灶数量分层为两组，M1（≤3个，“寡转移”）和M2（>3个，“多转移”）。主要结局是总生存期（OS）。次要结局是癌症特异性生存期（CSS）。采用Cox回归和Kaplan-Meier（KMA）分析评估结局，并采用受试者工作特征分析（ROC）评估与当前“M”分期相比的诊断准确性。
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