SURVIVAL AND PROGNOSTIC CLASSIFICATION OF PATIENTS WITH METASTATIC KIDNEY CANCER OF BONE
EXTERNAL VALIDATION OF THE MAYO CLINIC SIGN SCORE TO PREDICT CANCER-SPECIFIC SURVIVAL USING A EUROPEAN SERIES OF CONVENTIONAL RENAL CELL CARCINOMA
Toyoda Y., Shinohara N., Harabayashi T., Abe T., Akino T., Sazawa A., Nonomura K. Hokkaido University Graduate School of Medicine, Department of Urology, Sapporo, Japan INTRODUCTION & OBJECTIVES: Metastatic kidney cancer of bone is often associated with intractable pain and pathological fracture. Since the reports on the treatment to bone metastases of kidney cancer have limited, the treatment strategies are still unclear. We retrospectively analysed the records of 50 patients with metastases to bone, and investigated treatment outcomes and their prognostic factors in these patients. MATERIAL & METHODS: Between 1980 and 2004, a total of 50 patients with bone metastases of kidney cancer were treated in our department (mean age 62 years[range, 36 to 79 years]; mean follow-up 45.5 months [range, 0 to 294 months]). The relationship between several clinical features and survival was ﬁrst examined univariately. A Cox proportional hazards model was then used to form a multivariate model. RESULTS: Thirty-ﬁve of 50 patients experienced bone metastases by 24 months after the diagnosis of kidney cancer, 29 patients had extraosseous lesions at the occurrence of bone metastases, and 39 patients had some symptoms related to bone metastasis. Treatment for bone metastases (surgery in 11, radiation in 16, and surgery and radiation in 2) could relieve pain and allow good function in 29 patients. The median survival time from the occurrence of bone metastasis was 12 months and overall survival at 2 years was 37%. In the univariate analysis, clinical features associated with a prolonged survival were absence of venous thrombus in the primary tumour, longer interval between nephrectomy and occurrence of bone metastasis (more than 24 months), absence of extraosseous metastases and local treatment to bone metastasis. Multivariate analysis showed that longer interval between nephrectomy and occurrence of bone metastasis (HR 2.608; 95%CI 1.031-6.599) and absence of extraosseous metastases (HR 2.523; 95%CI 1.023-6.220) was independent factors predicting prolonged survival . By combining these two factors, kidney cancer patients with bone metastases could be categorized into two different groups. The median time to death in 20 patients with zero favourable factors (poor-risk) was 5 months. On the other hand, 30 patients had one or two favourable factors (good-risk) and the median survival time in this group was 30 months. There was a signiﬁcant difference in survival duration between two groups (p<0.001). CONCLUSIONS: Two prognostic factors predicting survival were identiﬁed and used to categorize kidney cancer patients with metastasis to bone into two risk groups. Local treatment for bone metastases allows for a prolonged survival as well as palliation in selected patients.
Ficarra V.1, Lohse C.2, Novara G.1, Galfano A.1, Cavalleri S.1, Martignoni G.3, Artibani W.1 1
University of Verona, Urology, Verona, Italy, 2Mayo Medical School, Urology, Rochester, United States, 3University of Verona, Pathology, Verona, Italy INTRODUCTION & OBJECTIVES: To validate the Mayo Clinic SSIGN (Stage, Size, Grade and Necrosis) Score using an independent European sample of patients who were surgically treated for conventional RCC. MATERIAL & METHODS: We identiﬁed 388 patients who were treated with radical or partial nephrectomy for conventional RCC between 1986 and 2000 from our Kidney Cancer Database. The associations of the pathologic studied features with death from RCC were evaluated using log-rank tests and Cox proportional hazards regression models. The predictive abilities of competing models were evaluated using the concordance index. RESULTS: The median duration of follow-up for the 290 patients who were still alive at last follow-up was 5 years (range 5 months to 17 years). The estimated cancer-speciﬁc survival rate at 5 years following surgery was 81.3%. All features that make up the SSIGN score, except tumour size, were signiﬁcantly associated with death from RCC in a multivariate setting, resulting in a c index of 0.90. The median SSIGN score for the 388 patients studied was 3 (range 0 - 15). The concordance index from a model containing the clear cell SSIGN score was 0.88. The 5-year cancer-speciﬁc survival rates for patients with scores of 0-2, 3-4, 5-6, 7-9, and 10 or more were 100.0%, 90.5%, 63.6%, 46.8%, and 0%, respectively. CONCLUSIONS: We provide the ﬁrst external validation of the Mayo Clinic SSIGN score for conventional RCC. This simple algorithm resulted in a high degree of prognostic accuracy.
RENAL TUMOURS BETWEEN 3 AND 4CM SHOW SIGNIFICANTLY MORE AGGRESSIVE PARAMETERS THAN TUMOURS EQUAL OR LESS THAN 3CM. AN ANALYSIS OF 287 RENAL TUMOURS ≤4CM
ANALYSIS OF CLINICAL- PATHOLOGICAL FEATURES AND SURVIVAL FOR PATIENTS UNDER THE AGE OF 40 WITH RENAL CORTICAL TUMOURS
Remzi M.1, Klingler H.C.1, Öszoy M.1, Susani M.2, Waldert M.1, Seitz C.1, Tanovic E.2, Dobrovits M.2, Schmidbauer J.1, Marberger M.1 1
Medical University of Vienna, of Urology, Vienna, Austria, 2Medical University of Vienna, of Pathology, Vienna, Austria INTRODUCTION & OBJECTIVES: Small renal tumours detected incidentally are considered to have less aggressive potential. This assumption is mainly based on their low tendency to increase in size at serial imaging studies, but histopathological parameters of progression in larger patient series are scant.
Ordonez M.1, Snyder M.1, Iasonos A.2, Secin F.1, Russo P.1, Guillonneau B.1, Touijer K.1 1
Memorial Sloan-Kettering Cancer Center, Urology, New York, United States, 2Memorial
Sloan-Kettering Cancer Center, Biostatistics, New York, United States INTRODUCTION & OBJECTIVES: We compared the clinical presentation, surgical approach, histological subtypes and outcomes of patients under the age of 40 to patients over the age of 60 with renal cortical tumours. MATERIAL & METHODS: We reviewed the Memorial Sloan Kettering Cancer Center
MATERIAL & METHODS: 287 tumour bearing kidneys in which solid tumours ≤4cm in diameter were detected by cross-sectional imaging and subsequently removed surgically were reviewed. Tumour size as documented by preoperative CT scan was correlated to the histological diagnosis, and in case of malignancy to tumour type, pathological TNM stage and nuclear (Fuhrman) grade. With multifocal lesions the largest single tumour was considered as reference lesion, but multifocality was also considered as a separate parameter.
Nephrectomy Database between 1989 and 2005 and identiﬁed 106 patients under the age of
RESULTS: At a mean tumour diameter of 2.94 ± 0.87cm overall 65 (22.6%) of tumours were ≤2cm, 103 (35.9%) 2.1-3.0cm, and 119 (41.5%) 3.1-4cm in diameter. 56 (19.5%) tumours were found to be benign, with no correlation to tumour size (p=0.660, Pearson test). 227 (79.1%) were renal cell cancer (RCC) with 159 (70.0%) clear cell RCC, 47 (20.7%) papillary, 11 (4.8%) chromophob, and 10 others, with no correlation to tumour diameter. 31 (13.6%) of kidneys had multifocal RCC, with a signiﬁcant correlation to larger tumour diameter (p=0.048, linear regression) and papillary RCC subtype (p=0.018, linear regression). 2 (4.2%), 4 (5%) and 25 (25.5%) of RCC ≤2cm, 2.1-3cm, and 3.1-4cm in diameter had Fuhrman grade G3/4, respectively (p=0.0007, Pearson). Advanced stage (≥pT3a) was documented in 2 (4.2%), 12 (14.9%), and 35 (35.7%) for the same categories, respectively (p=0.0023). Whereas distant metastases were diagnosed in only 4 RCC patients with tumours ≤3cm this was in 10 (8.4%) of patients with RCC from 3.1-4cm (p=0.045).
(p=0.97). There was no signiﬁcant difference in the incidence of benign, multifocal or
CONCLUSIONS: The aggressive potential of small RCC increases dramatically beyond a tumour diameter of 3cm. Given the difﬁculty in measuring tumour diameters reliably by sequential imaging studies, the threshold for selecting patients for a surveillance strategy should be selected well under this parameter.
40 and 1206 patients over the age of 60 who presented for evaluation of renal masses. Chi square test was used to assess any differences between the proportions in the two groups. Kaplan Meier curves and log-rank tests were used to test for differences in the disease speciﬁc survival curves. RESULTS: Both groups of patients were evenly distributed over the study period bilateral renal tumours between the two groups. Younger patients, however, were more likely to present with local symptoms (43% vs. 24%, p<0.001) and receive a partial nephrectomy (49% vs. 31%, p<0.001). While the majority of patients in both groups had clear cell carcinoma (63.2% and 62.5%, respectively), younger patients were more likely to have chromophobe (14% vs. 7%) and less likely to have papillary (7.5% vs. 14%, p=0.007). Lymph node dissection was performed in 29% and 30% of patients respectively. Younger patients presented with signiﬁcantly more nodal metastases (8% vs. 2.5%, p=0.01). With a median follow-up of 31 months, the 5 year disease speciﬁc survival in patients with renal cell carcinoma (clear cell, chromophobe and papillary) was 91% for young patients and 88% for the older group (p=0.63). In patients with clear cell only, the 5 year disease speciﬁc survival was 89% and 87% respectively (p=0.73). CONCLUSIONS: Although younger patients were more likely to present with local symptoms and have lymph node metastases than older ones, we did not identify any statistically signiﬁcant differences in disease-speciﬁc survival between the two groups.
Eur Urol Suppl 2006;5(2):107