Department of Urology, Mayo Clinic, Rochester, Minnesota.
Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
J Urol. 2023 Oct;210(4):611-618. doi: 10.1097/JU.0000000000003601. Epub 2023 Jun 20.
Multiple prognostic models exist to assess survival among patients with metastatic clear cell renal cell carcinoma. However, the relative contribution of histopathological features of the metastasis has not been extensively studied. Herein, we compared models using clinical, primary tumor, and metastatic features to predict cancer-specific survival for patients with surgically resected metastatic clear cell renal cell carcinoma.
We studied 266 patients who had undergone nephrectomy between 1970 and 2019, and who had a single site of metastasis completely resected. Two versions of the metastatic clear cell renal cell carcinoma score published by Leibovich et al were calculated, using grade and necrosis from the primary tumor and using grade and necrosis from the metastasis. Predictive abilities of these 2 versions and a third model that included metastatic features only were compared using c-indexes from Cox proportional hazards models.
A total of 197 patients died from renal cell carcinoma at a median of 2.3 years (IQR 1.1-4.5); median follow-up among survivors was 13.2 years (IQR 10.0-14.5). The Leibovich score using grade and necrosis from the metastasis (c=0.679) had similar predictive ability compared to the original Leibovich score using grade and necrosis from the primary tumor (c=0.675). A third model (c=0.707) demonstrated that metastasectomy within 2 years after nephrectomy, presence of bone metastasis, high grade, and sarcomatoid differentiation in the metastasis were significantly associated with cancer-specific survival.
Scoring algorithms calculated using histopathological features of the metastasis can be used to predict cancer-specific survival for patients with surgically resected metastatic clear cell renal cell carcinoma. These findings are of particular importance for instances when primary tumor histopathology is not readily available.
目前存在多种用于评估转移性透明细胞肾细胞癌患者生存情况的预后模型。然而，转移灶的组织病理学特征的相对贡献尚未得到广泛研究。在此，我们比较了使用临床、原发肿瘤和转移灶特征来预测接受手术切除的转移性透明细胞肾细胞癌患者的癌症特异性生存的模型。
我们研究了 266 例在 1970 年至 2019 年间接受肾切除术且单个转移部位完全切除的患者。我们计算了 Leibovich 等人发表的两种转移性透明细胞肾细胞癌评分版本，分别使用原发肿瘤的分级和坏死以及转移灶的分级和坏死。使用 Cox 比例风险模型的 C 指数比较了这两种版本以及仅包含转移灶特征的第三种模型的预测能力。
共有 197 例患者在中位 2.3 年（IQR 1.1-4.5）时死于肾细胞癌；幸存者的中位随访时间为 13.2 年（IQR 10.0-14.5）。使用转移灶分级和坏死的 Leibovich 评分（c=0.679）与使用原发肿瘤分级和坏死的原始 Leibovich 评分（c=0.675）具有相似的预测能力。第三种模型（c=0.707）表明，肾切除术后 2 年内进行转移灶切除术、存在骨转移、高级别和转移灶中出现肉瘤样分化与癌症特异性生存显著相关。
使用转移灶组织病理学特征计算的评分算法可用于预测接受手术切除的转移性透明细胞肾细胞癌患者的癌症特异性生存。这些发现对于无法获得原发肿瘤组织病理学的情况尤为重要。
