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Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN Project).
- Source :
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European urology [Eur Urol] 2013 Sep; Vol. 64 (3), pp. 472-7. Date of Electronic Publication: 2012 Jun 22. - Publication Year :
- 2013
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Abstract
- Background: Approximately 10-20% of recurrences in patients treated with nephrectomy for renal cell carcinoma (RCC) develop beyond 5 yr after surgery (late recurrence).<br />Objective: To determine features associated with late recurrence.<br />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]).<br />Interventions: Patients underwent radical nephrectomy or nephron-sparing surgery.<br />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).<br />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.<br />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.<br /> (Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Aged
Carcinoma, Renal Cell mortality
Carcinoma, Renal Cell secondary
Chi-Square Distribution
Databases, Factual
Disease-Free Survival
Female
Humans
Kidney Neoplasms mortality
Kidney Neoplasms pathology
Logistic Models
Lymphatic Metastasis
Male
Middle Aged
Multivariate Analysis
Neoplasm Grading
Neoplasm Staging
Odds Ratio
Predictive Value of Tests
Proportional Hazards Models
Reproducibility of Results
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Carcinoma, Renal Cell surgery
Decision Support Techniques
Kidney Neoplasms surgery
Neoplasm Recurrence, Local
Nephrectomy adverse effects
Nephrectomy mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1873-7560
- Volume :
- 64
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- European urology
- Publication Type :
- Academic Journal
- Accession number :
- 22748912
- Full Text :
- https://doi.org/10.1016/j.eururo.2012.06.030