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Meagher MF, Mir MC, Minervini A, Kriegmair M, Heck M, Porpiglia F, Van Bruwaene S, Linares E, Hevia V, D’Anna M, Veccia A, Roussel E, Claps F, Palumbo C, Marchioni M, Afari J, Saitta C, Liu F, Rubio J, Campi R, Mari A, Amiel T, Checcucci E, Musquera M, Guruli G, Pavan N, Albersen M, Antonelli A, Klatte T, Autorino R, McKay RR, Derweesh IH. Proposal for a Two-Tier Re-classification of Stage IV/M1 domain of Renal Cell Carcinoma into M1 (“Oligometastatic”) and M2 (“Polymetastatic”) subdomains: Analysis of the Registry for Metastatic Renal Cell Carcinoma (REMARCC). Front Oncol 2023; 13:1113246. [PMID: 37064092 PMCID: PMC10092360 DOI: 10.3389/fonc.2023.1113246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/12/2023] [Indexed: 03/31/2023] Open
Abstract
PurposeWe 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).MethodsMulticenter 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.Results429 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).ConclusionSubclassification 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.
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Affiliation(s)
- Margaret F. Meagher
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
| | - Maria C. Mir
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | | | - Matthias Heck
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Francesco Porpiglia
- Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Orbassano, Italy
| | | | | | - Vital Hevia
- Department of Urology, Hospital Ramon y Cajal, Madrid, Spain
| | - Maurizio D’Anna
- Department of Urology, Hospital Clinic, Carrer de Villarroel, Barcelona, Spain
| | - Alessandro Veccia
- Department of Urology, Virginia Commonwealth University (VCU) Medical Center, Richmond, VA, United States
| | | | - Francesco Claps
- Department of Urology, University of Trieste, Trieste, Italy
| | - Carlotta Palumbo
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Michele Marchioni
- Department of Urology, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Jonathan Afari
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
| | - Cesare Saitta
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
| | - Franklin Liu
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
| | - Jose Rubio
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Thomas Amiel
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Enrico Checcucci
- Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Mireia Musquera
- Department of Urology, Hospital Clinic, Carrer de Villarroel, Barcelona, Spain
| | - Georgi Guruli
- Department of Urology, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Urology, University of Trieste, Trieste, Italy
| | | | - Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Riccardo Autorino
- Department of Urology, Virginia Commonwealth University (VCU) Medical Center, Richmond, VA, United States
| | - Rana R. McKay
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
| | - Ithaar H. Derweesh
- Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States
- *Correspondence: Ithaar H. Derweesh,
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Impact of Metastasectomy on Cancer Specific and Overall Survival in Metastatic Renal Cell Carcinoma: Analysis of the REMARCC registry. Clin Genitourin Cancer 2022; 20:326-333. [DOI: 10.1016/j.clgc.2022.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/27/2021] [Accepted: 03/21/2022] [Indexed: 12/18/2022]
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3
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Prognostic and Predictive Markers, and Stratifications Tables, for the Detection and Treatment of Renal Cell Carcinoma. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Predictors of Cancer-specific Survival After Disease Recurrence in Patients With Renal Cell Carcinoma: The Effect of Time to Recurrence. Clin Genitourin Cancer 2018; 16:e903-e908. [DOI: 10.1016/j.clgc.2018.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/16/2018] [Accepted: 03/18/2018] [Indexed: 12/27/2022]
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Sastre-Heres AJ, Iglesias I, Alaguero-Calero M, Ruiz-Sánchez D, García-Díaz B, Peña-Díaz J. Comparative Study of Different Classification Models in Renal-Cell Carcinoma. Pathol Oncol Res 2018; 25:1357-1362. [PMID: 29455379 DOI: 10.1007/s12253-018-0385-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
The aim of this study was to compare the Memorial Sloan-Kettering Cancer Center (MSKCC) and the Cleveland Clinic Foundation (CCF) models of classification of aRCC patients. In addition, the model developed from the pivotal trial of temsirolimus and those proposed by Motzer et al. in 2004, Escudier et al., Heng et al., Choueiri et al. and Bamias et al. were examined. An observational, retrospective study of patients starting first-line systemic therapy was conducted between 2008 and 2011. The variables used to evaluate the classification models were median overall survival (mOS) and median progression-free survival (mPFS). The comparison of different classification models was performed by comparing the area under the ROC (Receiver Operating Characteristic) curve (AUC) for time-dependent variables proposed by Heagerty. Eighty-eight patients were included. When the different models were compared, it was found that although based on the mOS, the Escudier model had better short-term (1-year) prognostic value, followed by the Heng model; in the long term, the models that presented a higher prognosis capacity were the Hudes and CCF models, closely followed by the Heng model. In addition, the Heng model had a slightly higher predictive ability than the other models. Based on the results, and in line with the European society for medical oncology (ESMO) guidelines, it appears that the model of Heng could be the best model to classify patients with aRCC and combines good short- and long-term prognostics while possessing better predictive ability and a more equal distribution of patients.
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Affiliation(s)
- Alejandro José Sastre-Heres
- Servicio de Farmacia, Hospital San Juan de Dios de Zaragoza, C/Paseo Colón n°14, 50006, Zaragoza, Spain. .,Faculy of Pharmacy, University Complutense of Madrid, Ciudad Universitaria, Plaza Ramon y Cajal, 28040, Madrid, Spain.
| | - Irene Iglesias
- Faculy of Pharmacy, University Complutense of Madrid, Ciudad Universitaria, Plaza Ramon y Cajal, 28040, Madrid, Spain
| | - Miguel Alaguero-Calero
- Hospital Pharmacy Department, Hospital Universitario Central de Asturias, C/ Julián Clavería s/n, 33006, Oviedo, Asturias, Spain
| | - Daniel Ruiz-Sánchez
- Hospital Pharmacy Department, Hospital Universitario Central de Asturias, C/ Julián Clavería s/n, 33006, Oviedo, Asturias, Spain
| | - Benito García-Díaz
- Hospital Universitario Severo Ochoa, C/ Avenida de Orellana, s/n, 28911 Leganés, Madrid, Spain
| | - Jaime Peña-Díaz
- Faculty of Pharmacy, (Spanish Society of Hospital Pharmacy)-University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
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Prognostic and Predictive Markers, and Stratifications Tables, for the Detection and Treatment of Renal Cell Carcinoma. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_57-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Shinohara N, Obara W, Tatsugami K, Naito S, Kamba T, Takahashi M, Murai S, Abe T, Oba K, Naito S. Prognosis of Japanese patients with previously untreated metastatic renal cell carcinoma in the era of molecular-targeted therapy. Cancer Sci 2015; 106:618-26. [PMID: 25711777 PMCID: PMC4452164 DOI: 10.1111/cas.12646] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/14/2015] [Accepted: 02/22/2015] [Indexed: 02/02/2023] Open
Abstract
A multicenter cooperative study was conducted to clarify the prognosis of Japanese patients with metastatic renal cell carcinoma in the era of molecular-targeted therapy and the clinical usefulness of the Japanese metastatic renal cancer (JMRC) prognostic classification. Of 389 consecutive patients for whom treatment was started between 2008 and 2010 at 23 hospitals in Japan, 357 patients who received vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI) or cytokine as initial systemic therapy were the subject of the present study. Patients were classified into three prognostic groups according to the JMRC prognostic classification. The endpoints were progression-free survival (PFS) and overall survival (OS) after the start of the initial treatment. The median PFS and OS for the entire cohort of 357 patients were 9.1 and 27.2 months, respectively. VEGFR-TKI were selected for patients with multiple organ metastases, those with liver metastasis, and those with bone metastasis. The median PFS and OS were 11.0 and 23.2 months and 5.4 and 38.2 months in the VEGFR-TKI group and the cytokines group, respectively. The JMRC prognostic classification was useful as a prognostic model for PFS and OS (c-indexes: 0.613 and 0.630 in patients who initially received VEGFR-TKI and 0.647 and 0.642 in patients who received cytokines, respectively). The present study showed for the first time the prognosis of Japanese patients with metastatic renal cell carcinoma in the era of molecular-targeted therapy. The JMRC prognostic classification may be clinically useful as a prognostic model.
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Affiliation(s)
- Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wataru Obara
- Department of Urology, Iwate Medical University, Morioka, Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Sei Naito
- Department of Urology, Graduate School of Medicine, Yamagata University, Yamagata, Japan
| | - Tomomi Kamba
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masayuki Takahashi
- Department of Urology, Graduate School, University of Tokushima, Tokushima, Japan
| | - Sachiyo Murai
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Koji Oba
- Department of Biotatistics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Seiji Naito
- Department of Urology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
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Pan QZ, Wang QJ, Dan JQ, Pan K, Li YQ, Zhang YJ, Zhao JJ, Weng DS, Tang Y, Huang LX, He J, Chen SP, Ke ML, Chen MS, Wicha MS, Chang AE, Zeng YX, Li Q, Xia JC. A nomogram for predicting the benefit of adjuvant cytokine-induced killer cell immunotherapy in patients with hepatocellular carcinoma. Sci Rep 2015; 5:9202. [PMID: 25776856 PMCID: PMC4361845 DOI: 10.1038/srep09202] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/24/2015] [Indexed: 02/06/2023] Open
Abstract
The benefits of adjuvant cytokine-induced killer (CIK) cell immunotherapy for hepatocellular carcinoma (HCC) remain mixed among patients. Here, we constructed a prognostic nomogram to enable individualized predictions of survival benefit of adjuvant CIK cell treatment for HCC patients. Survival analysis showed that the median overall survival (OS) and progression-free survival (PFS) for patients in the hepatectomy/CIK combination group were 41 and 16 months, respectively, compared to 28 and 12 months for patients in the hepatectomy alone group (control). Based on multivariate analysis of the entire cohort, independent factors for OS were tumor size, tumor capsule, pathological grades, total bilirubin, albumin, prothrombin time, alpha-fetoprotein, and tumor number, which were incorporated into the nomogram. The survival prediction model performed well, as assessed by the c-index and calibration curve. Internal validation revealed a c-index of 0.698, which was significantly greater than the c-index value of the TNM (tumor–node–metastasis) staging systems of 0.634. The calibration curves fitted well. In conclusions, our developed nomogram resulted in more accurate individualized predictions of the survival benefit from adjuvant CIK cell treatment after hepatectomy. The model may provide valuable information to aid in the decision making regarding the application of adjuvant CIK cell immunotherapy.
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Affiliation(s)
- Qiu-Zhong Pan
- 1] Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China [2] Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qi-Jing Wang
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jia-Qiang Dan
- Department of Gastrointestinal Surgery, Chengdu Fifth People's Hospital, Sichuan, China
| | - Ke Pan
- 1] Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China [2] Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yong-Qiang Li
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yao-Jun Zhang
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing-Jing Zhao
- 1] Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China [2] Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - De-Sheng Weng
- 1] Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China [2] Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yan Tang
- 1] Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China [2] Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Li-Xi Huang
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jia He
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Shi-Ping Chen
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Miao-La Ke
- Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Min-Shan Chen
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Max S Wicha
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan 48109, USA
| | - Alfred E Chang
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan 48109, USA
| | - Yi-Xin Zeng
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qiao Li
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan 48109, USA
| | - Jian-Chuan Xia
- 1] Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China [2] Department of Biotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Nouhaud FX, Rebibo JD, Blanchard F, Sabourin JC, Di Fiore F, Pfister C. Valeur pronostique de la toxicité induite par les thérapies ciblées dans le carcinome rénal métastatique. Prog Urol 2014; 24:563-71. [DOI: 10.1016/j.purol.2013.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 07/29/2013] [Accepted: 12/05/2013] [Indexed: 01/26/2023]
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Bamias A, Tzannis K, Papatsoris A, Oudard S, Beuselinck B, Escudier B, Liontos M, Elaidi TR, Chrisofos M, Stravodimos K, Anastasiou I, Mitropoulos D, Deliveliotis C, Constantinides C, Dimopoulos MA, Bamia C. Prognostic significance of cytoreductive nephrectomy in patients with synchronous metastases from renal cell carcinoma treated with first-line sunitinib: a European multiinstitutional study. Clin Genitourin Cancer 2014; 12:373-83. [PMID: 24819319 DOI: 10.1016/j.clgc.2014.03.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/04/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION/BACKGROUND The aim of this study was to evaluate the prognostic role of CN in patients with mRCC and synchronous metastases treated with the VEGF receptor TKI, sunitinib. PATIENTS AND METHODS Patients with a diagnosis of metastases before, at the time of, or within 3 months from the diagnosis of renal cell carcinoma (RCC) and first-line treatment with sunitinib were included. Baseline characteristics were correlated with overall survival (OS) according to hazard ratios estimated from univariate Cox proportional hazards models. Significant factors were then included in a multivariate Cox proportional hazards model. RESULTS One hundred eighty-six patients treated between January 2006 and March 2012 were selected. Thirty-six (19%) had not undergone CN. CN was offered to younger patients with better prognoses. Patients who underwent CN lived significantly longer than patients without CN (median OS, 23.9 [95% confidence interval (CI), 20.8-28.8] vs. 9 [95% CI, 4-16.4] months; P < .001). Multivariate analysis showed that CN had an independent prognostic significance. No specific subgroup benefiting from CN was identified. CONCLUSION CN was an independent favorable prognostic factor in patients with synchronous metastases from RCC, treated with sunitinib. Information regarding the selection of mRCC patients likely to benefit from CN might be derived by ongoing phase III trials.
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Affiliation(s)
- Aristotle Bamias
- Dept of Clinical Therapeutics, University of Athens, Athens, Greece; Hellenic Genito-Urinary Cancer Group (HGUCG).
| | - Kimon Tzannis
- Dept of Clinical Therapeutics, University of Athens, Athens, Greece; Hellenic Genito-Urinary Cancer Group (HGUCG)
| | - Athanasios Papatsoris
- Hellenic Genito-Urinary Cancer Group (HGUCG); Second Urology Department, University of Athens, Athens, Greece
| | - Stéphane Oudard
- Dept of General Medical Oncology and Laboratory for Experimental Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | | | - Michalis Liontos
- Dept of Clinical Therapeutics, University of Athens, Athens, Greece
| | | | - Michael Chrisofos
- Hellenic Genito-Urinary Cancer Group (HGUCG); Second Urology Department, University of Athens, Athens, Greece
| | - Konstantinos Stravodimos
- Hellenic Genito-Urinary Cancer Group (HGUCG); First Urology Department, University of Athens, Athens, Greece
| | | | - Dionisios Mitropoulos
- Hellenic Genito-Urinary Cancer Group (HGUCG); First Urology Department, University of Athens, Athens, Greece
| | - Charalambos Deliveliotis
- Hellenic Genito-Urinary Cancer Group (HGUCG); Second Urology Department, University of Athens, Athens, Greece
| | - Constantinos Constantinides
- Hellenic Genito-Urinary Cancer Group (HGUCG); First Urology Department, University of Athens, Athens, Greece
| | | | - Christina Bamia
- Hellenic Genito-Urinary Cancer Group (HGUCG); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Athens, Greece
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Stenman M, Laurell A, Lindskog M. Prognostic significance of serum albumin in patients with metastatic renal cell carcinoma. Med Oncol 2014; 31:841. [PMID: 24477648 DOI: 10.1007/s12032-014-0841-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/09/2014] [Indexed: 01/29/2023]
Abstract
Systemic inflammation has been suggested to impact on the prognosis of metastatic renal cell carcinoma (mRCC). We undertook a retrospective analysis of patients with mRCC treated at Akademiska University Hospital in Sweden during the years 2005-2012 to assess the possible prognostic significance of inflammation-related factors including serum albumin, platelet count, weight loss and C-reactive protein (CRP). The Memorial Sloan-Kettering Cancer Center (MSKCC) criteria for prognosis of mRCC and ECOG performance status were assessed for all patients. Overall survival (OS) and progression-free survival (PFS) were calculated according to Kaplan-Meier, and Cox proportional hazards regression was used for uni- and multivariate analyses. The median OS of all patients (n=84) was 20 months. Univariate analysis identified low serum albumin (HR=4.17, p<0.001), elevated platelet count (HR=2.98, p<0.001) and patient-reported weight loss prior to diagnosis of mRCC (HR=2.73, p<0.001), in addition to MSKCC (HR=3.35, p=0.0088) to be associated with shorter OS. CRP did not significantly affect OS. Serum albumin retained prognostic significance for OS in multivariate analysis (HR=2.72, p=0.015). In patients treated with an angiogenesis-targeted agent (n=47), low serum albumin level (HR=4.63, p<0.001) and elevated platelet count (HR=2.11, p=0.022) were associated with shorter PFS. In contrast, CRP, weight loss and MSKCC risk group did not significantly affect PFS. In multivariate analysis serum albumin remained associated with PFS (HR=3.92, p=0.0035). Our findings identify serum albumin as an independent prognostic factor for patients with mRCC treated with angiogenesis-targeted therapy.
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Affiliation(s)
- Maria Stenman
- Unit of Oncology, Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden,
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Previs RA, Bevis KS, Huh W, Tillmanns T, Perry L, Moore K, Chapman J, McClung C, Kiet T, Java J, Chan J, Secord AA. A prognostic nomogram to predict overall survival in women with recurrent ovarian cancer treated with bevacizumab and chemotherapy. Gynecol Oncol 2014; 132:531-6. [PMID: 24472410 DOI: 10.1016/j.ygyno.2014.01.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 01/10/2014] [Accepted: 01/20/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To develop a nomogram to predict overall survival (OS) in women with recurrent ovarian cancer treated with bevacizumab and chemotherapy. METHODS A multicenter retrospective study was conducted. Potential prognostic variables included age; stage; grade; histology; performance status; residual disease; presence of ascites and/or pleural effusions; number of chemotherapy regimens, treatment-free interval (TFI) prior to bevacizumab administration, and platinum sensitivity. Multivariate analysis was performed using Cox proportional hazards regression. The predictive model was developed into a nomogram to predict five-year OS. RESULTS 312 women with recurrent ovarian cancer treated with bevacizumab and chemotherapy were identified; median age was 59 (range: 19-85); 86% women had advanced stage (III-IV) disease. The majority had serous histology (74%), high grade cancers (93.5%), and optimal cytoreductions (69.5%). Fifty-one percent of women received greater than two prior chemotherapeutic regimens. TFI (AHR=0.98, 95% CI 0.97-1.00, p=0.022) was the only statistically significant predictor in a multivariate progression-free survival (PFS) analysis. In a multivariate OS analysis, prior number of chemotherapy regimens, TFI, platinum sensitivity, and presence of ascites were significant. A nomogram to predict five-year OS was constructed and internally validated (bootstrap-corrected concordance index=0.737). CONCLUSION Our multivariate model identified prior number of chemotherapy regimens, TFI, platinum sensitivity, and the presence of ascites as prognostic variables for OS in women with recurrent ovarian cancer treated with bevacizumab combined with chemotherapy. Our nomogram to predict five-year OS may be used to identify women who may benefit from bevacizumab and chemotherapy, but further validation is needed.
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Affiliation(s)
- R A Previs
- Duke University Medical Center, Durham, NC, USA.
| | - K S Bevis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - W Huh
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - T Tillmanns
- West Clinic and University of Tennessee Health Science Center, Memphis, TN, USA
| | - L Perry
- Stevenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - K Moore
- Stevenson Oklahoma Cancer Center at the University of Oklahoma, Oklahoma City, OK, USA
| | - J Chapman
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Stanford Women's Cancer Center, Stanford Hospital and Clinics, Palo Alto, CA, USA
| | - C McClung
- Stanford Women's Cancer Center, Stanford Hospital and Clinics, Palo Alto, CA, USA
| | - T Kiet
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - J Java
- Gynecologic Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - J Chan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
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Bamias A, Tzannis K, Beuselinck B, Oudard S, Escudier B, Diosynopoulos D, Papazisis K, Lang H, Wolter P, de Guillebon E, Stravodimos K, Chrisofos M, Fountzilas G, Elaidi RT, Dimopoulos MA, Bamia C. Development and validation of a prognostic model in patients with metastatic renal cell carcinoma treated with sunitinib: a European collaboration. Br J Cancer 2013; 109:332-41. [PMID: 23807171 PMCID: PMC3721408 DOI: 10.1038/bjc.2013.341] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/07/2013] [Accepted: 06/09/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Accurate prediction of outcome for metastatic renal cell carcinoma (mRCC) patients receiving targeted therapy is essential. Most of the available models have been developed in patients treated with cytokines, while most of them are fairly complex, including at least five factors. We developed and externally validated a simple model for overall survival (OS) in mRCC. We also studied the recently validated International Database Consortium (IDC) model in our data sets. METHODS The development cohort included 170 mRCC patients treated with sunitinib. The final prognostic model was selected by uni- and multivariate Cox regression analyses. Risk groups were defined by the number of risk factors and by the 25th and 75th percentiles of the model's prognostic index distribution. The model was validated using an independent data set of 266 mRCC patients (validation cohort) treated with the same agent. RESULTS Eastern Co-operative Oncology Group (ECOG) performance status (PS), time from diagnosis of RCC and number of metastatic sites were included in the final model. Median OS of patients with 1, 2 and 3 risk factors were: 24.7, 12.8 and 5.9 months, respectively, whereas median OS was not reached for patients with 0 risk factors. Concordance (C) index for internal validation was 0.712, whereas C-index for external validation was 0.634, due to differences in survival especially in poor-risk populations between the two cohorts. Predictive performance of the model was improved after recalibration. Application of the mRCC International Database Consortium (IDC) model resulted in a C-index of 0.574 in the development and 0.576 in the validation cohorts (lower than those recently reported for this model). Predictive ability was also improved after recalibration in this analysis. Risk stratification according to IDC model showed more similar outcomes across the development and validation cohorts compared with our model. CONCLUSION Our model provides a simple prognostic tool in mRCC patients treated with a targeted agent. It had similar performance with the IDC model, which, however, produced more consistent survival results across the development and validation cohorts. The predictive ability of both models was lower than that suggested by internal validation (our model) or recent published data (IDC model), due to differences between observed and predicted survival among intermediate and poor-risk patients. Our results highlight the importance of external validation and the need for further refinement of existing prognostic models.
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Affiliation(s)
- A Bamias
- Department of Clinical Therapeutics, University of Athens, Athens, Greece.
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Margulis V, Shariat SF, Rapoport Y, Rink M, Sjoberg DD, Tannir NM, Abel EJ, Culp SH, Tamboli P, Wood CG. Development of accurate models for individualized prediction of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma. Eur Urol 2012; 63:947-52. [PMID: 23273681 DOI: 10.1016/j.eururo.2012.11.040] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 11/15/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is limited evidence to guide patient selection for cytoreductive nephrectomy (CN) following the diagnosis of metastatic renal cell carcinoma (mRCC). OBJECTIVE Given the significant variability in oncologic outcomes following surgery, we sought to develop clinically relevant, individualized, multivariable models for the prediction of cancer-specific survival at 6 and 12 mo after CN. The development of this nomogram will better help clinicians select patients for cytoreductive surgery. DESIGN, SETTING, AND PARTICIPANTS We identified 601 consecutive patients who underwent CN for kidney cancer at a single tertiary cancer center. INTERVENTION CN for mRCC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The development cohort was used to select predictive variables from a large group of candidate predictors. The discrimination, calibration, and decision curves were corrected for overfit using 10-fold crossvalidation that included stepwise variable selection. RESULTS AND LIMITATIONS With a median follow-up of 65 mo (range: 6-199) for the entire cohort, 110 and 215 patients died from kidney cancer at 6 and 12 mo after surgery, respectively. For the preoperative model, serum albumin and serum lactate dehydrogenase were included. Final pathologic primary tumor stage, nodal stage, and receipt of blood transfusion were added to the previously mentioned parameters for the postoperative model. Preoperative and postoperative nomograms demonstrated good discrimination of 0.76 and 0.74, respectively, when applied to the validation data set. Both models demonstrated excellent calibration and a good net benefit over large ranges of threshold probabilities. The retrospective study design is the major limitation of this study. CONCLUSIONS We have developed models for accurate prediction of cancer-specific survival after CN, using either preoperative or postoperative variables. While these tools need validation in independent cohorts, our results suggest that the models are informative and can be used to aid in clinical decision making.
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Affiliation(s)
- Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 77030, USA
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Meskawi M, Sun M, Trinh QD, Bianchi M, Hansen J, Tian Z, Rink M, Ismail S, Shariat SF, Montorsi F, Perrotte P, Karakiewicz PI. A Review of Integrated Staging Systems for Renal Cell Carcinoma. Eur Urol 2012; 62:303-14. [DOI: 10.1016/j.eururo.2012.04.049] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/24/2012] [Indexed: 11/28/2022]
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External validation of the preoperative Karakiewicz nomogram in a large multicentre series of patients with renal cell carcinoma. World J Urol 2012; 31:1285-90. [PMID: 22847452 DOI: 10.1007/s00345-012-0896-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 06/12/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To perform a formal external validation of the preoperative Karakiewicz nomogram (KN) for the prediction of cancer-specific survival (CSS) using a large series of surgically treated patients diagnosed with organ-confined or metastatic renal cell carcinoma (RCC). METHODS Patient population originated from a series of retrospectively gathered cases that underwent radical or partial nephrectomy between years 1995 and 2007 for suspicion of kidney cancer. The original Cox coefficients were used to generate the predicted risk of CSS at 1, 2, 5, and 10 years following surgery and compared to the observed risk of CSS in the current population. External validation was quantified using measures of predictive accuracy, defined as model discrimination and calibration. RESULTS A total of 3,374 patients were identified. Relative to the original development cohort, the current sample population had a larger proportion of patients with localized (40.0 vs. 26.3 %, P < 0.001) and non-metastatic (92.2 vs. 88.1 %, P = 0.03) disease at presentation. Model discrimination for the prediction of CSS was 87.8 % (95 % CI, 84.4-91.4) at 1 year, 87.0 % (95 % CI, 84.4-89.5) at 2 years, 84.7 % (95 % CI, 82.3-87.1) at 5 years, and 85.9 % (95 % CI, 83.2-88.6) at 10 years. The relationship between predicted and observed CSS risk was adequate in the calibration plot. CONCLUSION The use of the KN for the prediction of CSS in patients diagnosed with renal cell carcinoma was validated in the current study. In consequence, this tool may be recommended for routine clinical counseling in patients with various stages of RCC in the preoperative setting.
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Crispen PL, Blute ML. Role of cytoreductive nephrectomy in the era of targeted therapy for renal cell carcinoma. Curr Urol Rep 2012; 13:38-46. [PMID: 22105577 DOI: 10.1007/s11934-011-0225-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
With the advent of targeted therapy for the treatment of metastatic renal cancer, the routine use of cytoreductive nephrectomy has been questioned. However, available data suggest that cytoreductive nephrectomy remains an integral part of treatment in properly selected patients. This review details the rationale for the continued use of cytoreductive nephrectomy in acceptable surgical candidates in the era of targeted therapy.
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Affiliation(s)
- Paul L Crispen
- Department of Surgery, University of Kentucky, Lexington, KY 40513, USA
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Vermaat JS, Gerritse FL, van der Veldt AA, Roessingh WM, Niers TM, Oosting SF, Sleijfer S, Roodhart JM, Beijnen JH, Schellens JH, Gietema JA, Boven E, Richel DJ, Haanen JB, Voest EE. Validation of serum amyloid α as an independent biomarker for progression-free and overall survival in metastatic renal cell cancer patients. Eur Urol 2012; 62:685-95. [PMID: 22285764 DOI: 10.1016/j.eururo.2012.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 01/12/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND We recently identified apolipoprotein A2 (ApoA2) and serum amyloid α (SAA) as independent prognosticators in metastatic renal cell carcinoma (mRCC) patients, thereby improving the accuracy of the Memorial-Sloan Kettering Cancer Center (MSKCC) model. OBJECTIVE Validate these results prospectively in a separate cohort of mRCC patients treated with tyrosine kinase inhibitors (TKIs). DESIGN, SETTING, AND PARTICIPANTS For training we used 114 interferon-treated mRCC patients (inclusion 2001-2006). For validation we studied 151 TKI-treated mRCC patients (inclusion 2003-2009). MEASUREMENTS Using Cox proportional hazards regression analysis, SAA and ApoA2 were associated with progression-free survival (PFS) and overall survival (OS). In 72 TKI-treated patients, SAA levels were analyzed longitudinally as a potential early marker for treatment effect. RESULTS AND LIMITATIONS Baseline ApoA2 and SAA levels significantly predicted PFS and OS in the training and validation cohorts. Multivariate analysis identified SAA in both separate patient sets as a robust and independent prognosticator for PFS and OS. In contrast to our previous findings, ApoA2 interacted with SAA in the validation cohort and did not contribute to a better predictive accuracy than SAA alone and was therefore excluded from further analysis. According to the tertiles of SAA levels, patients were categorized in three risk groups, demonstrating accurate risk prognostication. SAA as a single biomarker showed equal prognostic accuracy when compared with the multifactorial MSKCC risk mode. Using receiver operating characteristic analysis, SAA levels >71 ng/ml were designated as the optimal cut-off value in the training cohort, which was confirmed for its significant sensitivity and specificity in the validation cohort. Applying SAA >71 ng/ml as an additional risk factor significantly improved the predictive accuracy of the MSKCC model in both independent cohorts. Changes in SAA levels after 6-8 wk of TKI treatment had no value in predicting treatment outcome. CONCLUSIONS SAA but not ApoA2 was shown to be a robust and independent prognosticator for PFS and OS in mRCC patients. When incorporated in the MSKCC model, SAA showed additional prognostic value for patient management.
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Affiliation(s)
- Joost S Vermaat
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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Prognostic Factors and Predictive Models in Renal Cell Carcinoma: A Contemporary Review. Eur Urol 2011; 60:644-61. [PMID: 21741163 DOI: 10.1016/j.eururo.2011.06.041] [Citation(s) in RCA: 246] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/20/2011] [Indexed: 12/24/2022]
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Di Lorenzo G. A Prognostic Model for Patients With Metastatic Renal Cell Cancer: What's New? Eur Urol 2011; 60:57-9. [DOI: 10.1016/j.eururo.2010.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 12/15/2010] [Indexed: 01/23/2023]
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