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1993 PROGNOSTIC ROLE OF MICROVASCULAR INVASION IN CLEAR CELL RENAL CELL CARCINOMA: RESULTS OF THE SATURN PROJECT
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THE JOURNAL OF UROLOGY姞
1993 PROGNOSTIC ROLE OF MICROVASCULAR INVASION IN CLEAR CELL RENAL CELL CARCINOMA: RESULTS OF THE SATURN PROJECT G. Novara*, Padua, Italy; A. Antonelli, Brescia, Italy; R. Bertini, Milan, Italy; G. Carmignani, Genova, Italy; S. Cosciani Cunico, Brescia, Italy; O. De Cobelli, Milan, Italy; A. Lapini, Florence, Italy; N. Longo, Naples, Italy; A. Minervini, Florence, Italy; F. Montorsi, Milan, Italy; S. Serni, Florence, Italy; A. Simonato, Genova, Italy; S. Siracusano, Trieste, Italy; A Volpe, Novara, Italy; F. Zattoni, V. Ficarra, Padua, Italy INTRODUCTION AND OBJECTIVES: To evaluate the prognostic role of microvascular invasion in a large multi-institutional series of patients undergoing radical or partial nephrectomy for clear cell renal cell carcinoma (RCC). METHODS: We collected retrospectively the data of 2083 patients who were surgically treated for clear cell RCC in 16 academic centers involved in the Surveillance And Treatment Update Renal Neoplasms (SATURN) project. Pathological slide review was not performed in these cases. RESULTS: Microvascular invasion was present in 283 (14%) patients. Patients with microvascular invasion showed several unfavorable clinical and pathologic characteristics, including symptoms at presentation, higher nuclear grade, higher pathological tumor size, higher pathological T stage, higher prevalence of lymph node and distant metastases (all p values ⬍0.001). At a median follow-up of 42 months (IQR 24 – 80), 393 patients (19%) had developed disease recurrence and 303 (15%) were dead of RCC. Five and 10-year cancer-specific survival (CSS) estimates were 88.7% (standard error [SE] 0.8%) and 82.3% (SE1.3%) in those patients without microvascular invasion, respectively, compared with 47.2% (SE 3.8%) and 36.2% (SE 4.7.4%), respectively, in patients with microvascular invasion (log rank p value ⬍0.0001). In univariable analysis, presence of microvascular invasion was significantly associated with CSS (H.R: 5.3; p⬍0.001). On multivariable Cox regression analyses that adjusted for the effect of for age, gender, symptoms, type of surgery, histological subtype, TNM stage, and Fuhrman grade, presence of microvascular invasion was an independent predictor of CSS (H.R. 1.4; p⫽0.027). CONCLUSIONS: Microvascular invasion was an independent predictor of CSS in patients with clear cell RCC, once adjusted for the effect of all the major clinical and pathological variables. Source of Funding: None
1994 EXTERNAL VALIDATION OF THE PREOPERATIVE KARAKIEWICZ NOMOGRAM IN A MULTI CENTER SERIE OF PATIENTS WITH RENAL CELL CARCINOMA TREATED WITH RADICAL OR PARTIAL NEPHRECTOMY P. Gontero*, Torino, Italy; G. Martorana, R. Schiavina, Bologna, Italy; A. Antonelli, C. Simeone, S. Cosciani Cunico, Brescia, Italy; A. Minervini, L. Masieri, Florence, Italy; A. Simonato, Genova, Italy; N. Longo, C. Imbimbo, Naples, Italy; F. Montorsi, Milan, Italy; G. Novara, Padua, Italy; A. Volpe, Novara, Italy; S. Siracusano, Trieste, Italy; R. Bertini, Milan, Italy; G. Carmignani, Genova, Italy; G. Morgia, Catania, Italy; V. Mirone, Naples, Italy; V. Ficarra, Padua, Italy INTRODUCTION AND OBJECTIVES: To validate the Karakiewicz nomogram using preoperative variables to predict cancer-specific survival of patients undergoing radical or partial nephrectomy for RCC. METHODS: We collected retrospectively the data of 3364 patients surgically treated for RCC in 16 academic centers involved in the Surveillance And Treatment Update Renal Neoplasms (SATURN) project. Univariable and multivariable Cox regression models addressed cancer-specific mortality. Concordance index was used to evaluate the prognostic accuracy of the nomogram 12, 24, 60, and 120 months after surgery.
Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011
RESULTS: All the variable included in the nomograms (age, gender, mode of presentation, clinical tumor size, clinical T stage, presence of metastasis) were independent predictor of CSS in multivariable analysis (all p values ⬍0.02). The prognostic accuracy of the nomogram was 87.8% (IC95% 84.4 –91.4) at 12-mo; 87% (IC95% 84.4 – 89.5) at 24-mo; 84% (IC95% 82.3– 87.1) at 60-mo; and 85.9% (IC95% 83.2-88.6) at 120-mo from surgery. Calibrations curve showed that the nomogram tended to significantly overestimate the rates of freedom from cancer-specific mortality a 60 and 120-mo, whereas the differences between estimates and observed rates at 12- and 24-mo were limited. CONCLUSIONS: Karakiewicz nomograms has a high prognostic accuracy both in short and long term evaluation of cancer-related outcome of patients with RCC. However, according to our series, the nomograms tend to underestimate the risk of cancer-specific deaths both 60 and 120-mo after surgery. Source of Funding: None
1995 PREDICTIVE FACTORS FOR LATE RECURRENCE OF RENAL CELL CARCINOMA Yong Hyun Park*, Young Ju Lee, In-sung Kim, Ja Hyeon Ku, Cheol Kwak, Hyeon Hoe Kim, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: We aimed to evaluate the clinical and pathologic features and predictive factors for late recurrence of RCC. METHODS: A total of 747 patients who had undergone curative surgery for RCC with follow up duration over 5 years or recurrence within 5 years were included in this study. Based on the recurrence duration, the patients were stratified into 4 groups; group 1 (no recurrence more than 5 years after surgery, n⫽425), group 2 (synchronous metastasis, n⫽138), group 3 (recurrence within 5 years, n⫽143), and group 4 (recurrence after 5 years, n⫽41). Multivariate analysis with multiple logistic regression analysis and Cox proportional hazards regression model was used to identify the pathologic and clinical factors affecting the late recurrence more than 5 years after surgery and its clinical outcome. RESULTS: The subgroups based on the recurrence duration were significantly different with respect to clinicopathologic parameters including age at initial diagnosis, preoperative hemoglobin, platelet, hs-CRP levels, pT stage, and nuclear grade. In multiple logistic regression analysis, age at diagnosis (OR 1.085, 95% CI 1.012–1.163, p⫽0.022), and preoperative hs-CRP level (OR 6.211, 95% CI 1.590 – 24.270, p⫽0.009) were independent prognostic factors for late recurrence more than 5 years after surgery. In group 2, 3, and 4, 5-year cancer-specific survival after recurrence were 27.0%, 41.1%, 73.7%, respectively (p⬍0.001). Multivariate analysis by Cox proportional hazard model indicated that late recurrence (HR 0.487, 95% CI 0.274 – 0.864, p⫽0.014), as well as age at diagnosis, initial presenting symptom, pT stage, histologic subtype, sarcomatoid differentiation, and lymphovascular invasion, were independent predicting factors for cancer-related death. CONCLUSIONS: Late recurrence of RCC is not a rare event, and age and serum hs-CRP at initial diagnosis may be independent predicting factors for late recurrence of RCC.
THE JOURNAL OF UROLOGY姞
1993 PROGNOSTIC ROLE OF MICROVASCULAR INVASION IN CLEAR CELL RENAL CELL CARCINOMA: RESULTS OF THE SATURN PROJECT G. Novara*, Padua, Italy; A. Antonelli, Brescia, Italy; R. Bertini, Milan, Italy; G. Carmignani, Genova, Italy; S. Cosciani Cunico, Brescia, Italy; O. De Cobelli, Milan, Italy; A. Lapini, Florence, Italy; N. Longo, Naples, Italy; A. Minervini, Florence, Italy; F. Montorsi, Milan, Italy; S. Serni, Florence, Italy; A. Simonato, Genova, Italy; S. Siracusano, Trieste, Italy; A Volpe, Novara, Italy; F. Zattoni, V. Ficarra, Padua, Italy INTRODUCTION AND OBJECTIVES: To evaluate the prognostic role of microvascular invasion in a large multi-institutional series of patients undergoing radical or partial nephrectomy for clear cell renal cell carcinoma (RCC). METHODS: We collected retrospectively the data of 2083 patients who were surgically treated for clear cell RCC in 16 academic centers involved in the Surveillance And Treatment Update Renal Neoplasms (SATURN) project. Pathological slide review was not performed in these cases. RESULTS: Microvascular invasion was present in 283 (14%) patients. Patients with microvascular invasion showed several unfavorable clinical and pathologic characteristics, including symptoms at presentation, higher nuclear grade, higher pathological tumor size, higher pathological T stage, higher prevalence of lymph node and distant metastases (all p values ⬍0.001). At a median follow-up of 42 months (IQR 24 – 80), 393 patients (19%) had developed disease recurrence and 303 (15%) were dead of RCC. Five and 10-year cancer-specific survival (CSS) estimates were 88.7% (standard error [SE] 0.8%) and 82.3% (SE1.3%) in those patients without microvascular invasion, respectively, compared with 47.2% (SE 3.8%) and 36.2% (SE 4.7.4%), respectively, in patients with microvascular invasion (log rank p value ⬍0.0001). In univariable analysis, presence of microvascular invasion was significantly associated with CSS (H.R: 5.3; p⬍0.001). On multivariable Cox regression analyses that adjusted for the effect of for age, gender, symptoms, type of surgery, histological subtype, TNM stage, and Fuhrman grade, presence of microvascular invasion was an independent predictor of CSS (H.R. 1.4; p⫽0.027). CONCLUSIONS: Microvascular invasion was an independent predictor of CSS in patients with clear cell RCC, once adjusted for the effect of all the major clinical and pathological variables. Source of Funding: None
1994 EXTERNAL VALIDATION OF THE PREOPERATIVE KARAKIEWICZ NOMOGRAM IN A MULTI CENTER SERIE OF PATIENTS WITH RENAL CELL CARCINOMA TREATED WITH RADICAL OR PARTIAL NEPHRECTOMY P. Gontero*, Torino, Italy; G. Martorana, R. Schiavina, Bologna, Italy; A. Antonelli, C. Simeone, S. Cosciani Cunico, Brescia, Italy; A. Minervini, L. Masieri, Florence, Italy; A. Simonato, Genova, Italy; N. Longo, C. Imbimbo, Naples, Italy; F. Montorsi, Milan, Italy; G. Novara, Padua, Italy; A. Volpe, Novara, Italy; S. Siracusano, Trieste, Italy; R. Bertini, Milan, Italy; G. Carmignani, Genova, Italy; G. Morgia, Catania, Italy; V. Mirone, Naples, Italy; V. Ficarra, Padua, Italy INTRODUCTION AND OBJECTIVES: To validate the Karakiewicz nomogram using preoperative variables to predict cancer-specific survival of patients undergoing radical or partial nephrectomy for RCC. METHODS: We collected retrospectively the data of 3364 patients surgically treated for RCC in 16 academic centers involved in the Surveillance And Treatment Update Renal Neoplasms (SATURN) project. Univariable and multivariable Cox regression models addressed cancer-specific mortality. Concordance index was used to evaluate the prognostic accuracy of the nomogram 12, 24, 60, and 120 months after surgery.
Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011
RESULTS: All the variable included in the nomograms (age, gender, mode of presentation, clinical tumor size, clinical T stage, presence of metastasis) were independent predictor of CSS in multivariable analysis (all p values ⬍0.02). The prognostic accuracy of the nomogram was 87.8% (IC95% 84.4 –91.4) at 12-mo; 87% (IC95% 84.4 – 89.5) at 24-mo; 84% (IC95% 82.3– 87.1) at 60-mo; and 85.9% (IC95% 83.2-88.6) at 120-mo from surgery. Calibrations curve showed that the nomogram tended to significantly overestimate the rates of freedom from cancer-specific mortality a 60 and 120-mo, whereas the differences between estimates and observed rates at 12- and 24-mo were limited. CONCLUSIONS: Karakiewicz nomograms has a high prognostic accuracy both in short and long term evaluation of cancer-related outcome of patients with RCC. However, according to our series, the nomograms tend to underestimate the risk of cancer-specific deaths both 60 and 120-mo after surgery. Source of Funding: None
1995 PREDICTIVE FACTORS FOR LATE RECURRENCE OF RENAL CELL CARCINOMA Yong Hyun Park*, Young Ju Lee, In-sung Kim, Ja Hyeon Ku, Cheol Kwak, Hyeon Hoe Kim, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: We aimed to evaluate the clinical and pathologic features and predictive factors for late recurrence of RCC. METHODS: A total of 747 patients who had undergone curative surgery for RCC with follow up duration over 5 years or recurrence within 5 years were included in this study. Based on the recurrence duration, the patients were stratified into 4 groups; group 1 (no recurrence more than 5 years after surgery, n⫽425), group 2 (synchronous metastasis, n⫽138), group 3 (recurrence within 5 years, n⫽143), and group 4 (recurrence after 5 years, n⫽41). Multivariate analysis with multiple logistic regression analysis and Cox proportional hazards regression model was used to identify the pathologic and clinical factors affecting the late recurrence more than 5 years after surgery and its clinical outcome. RESULTS: The subgroups based on the recurrence duration were significantly different with respect to clinicopathologic parameters including age at initial diagnosis, preoperative hemoglobin, platelet, hs-CRP levels, pT stage, and nuclear grade. In multiple logistic regression analysis, age at diagnosis (OR 1.085, 95% CI 1.012–1.163, p⫽0.022), and preoperative hs-CRP level (OR 6.211, 95% CI 1.590 – 24.270, p⫽0.009) were independent prognostic factors for late recurrence more than 5 years after surgery. In group 2, 3, and 4, 5-year cancer-specific survival after recurrence were 27.0%, 41.1%, 73.7%, respectively (p⬍0.001). Multivariate analysis by Cox proportional hazard model indicated that late recurrence (HR 0.487, 95% CI 0.274 – 0.864, p⫽0.014), as well as age at diagnosis, initial presenting symptom, pT stage, histologic subtype, sarcomatoid differentiation, and lymphovascular invasion, were independent predicting factors for cancer-related death. CONCLUSIONS: Late recurrence of RCC is not a rare event, and age and serum hs-CRP at initial diagnosis may be independent predicting factors for late recurrence of RCC.