An Outcome Prediction Model for Patients with Clear Cell Renal Cell Carcinoma Treated with Radical Nephrectomy Based on Tumor Stage, Size, Grade and Necrosis: The Ssign Score

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Dec 2002An Outcome Prediction Model for Patients with Clear Cell Renal Cell Carcinoma Treated with Radical Nephrectomy Based on Tumor Stage, Size, Grade and Necrosis: The Ssign Score IGOR FRANK, MICHAEL L. BLUTE, JOHN C. CHEVILLE, CHRISTINE M. LOHSE, AMY L. WEAVER, and HORST ZINCKE IGOR FRANKIGOR FRANK More articles by this author , MICHAEL L. BLUTEMICHAEL L. BLUTE More articles by this author , JOHN C. CHEVILLEJOHN C. CHEVILLE More articles by this author , CHRISTINE M. LOHSECHRISTINE M. LOHSE More articles by this author , AMY L. WEAVERAMY L. WEAVER More articles by this author , and HORST ZINCKEHORST ZINCKE More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64153-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Currently outcome prediction in renal cell carcinoma is largely based on pathological stage and tumor grade. We developed an outcome prediction model for patients treated with radical nephrectomy for clear cell renal cell carcinoma, which was based on all available clinical and pathological features significantly associated with death from renal cell carcinoma. Materials and Methods: We identified 1,801 adult patients with unilateral clear cell renal cell carcinoma treated with radical nephrectomy between 1970 and 1998. Clinical features examined included age, sex, smoking history, and signs and symptoms at presentation. Pathological features examined included 1997 TNM stage, tumor size, nuclear grade, histological tumor necrosis, sarcomatoid component, cystic architecture, multifocality and surgical margin status. Cancer specific survival was estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used to test associations between features studied and outcome. The selection of features included in the multivariate model was validated using bootstrap methodology. Results: Mean followup was 9.7 years (range 0.1 to 31). Estimated cancer specific survival rates at 1, 3, 5, 7 and 10 years were 86.6%, 74.0%, 68.7%, 63.8% and 60.0%, respectively. Several features were multivariately associated with death from clear cell renal cell carcinoma, including 1997 TNM stage (p <0.001), tumor size 5 cm. or greater (p <0.001), nuclear grade (p <0.001) and histological tumor necrosis (p <0.001). Conclusions: In patients with clear cell renal cell carcinoma 1997 TNM stage, tumor size, nuclear grade and histological tumor necrosis were significantly associated with cancer specific survival. We present a scoring system based on these features that can be used to predict outcome. References 1 : Pathologic staging of renal cell carcinoma: significance of tumor classification with the 1997 TNM staging system. Cancer2001; 91: 354. Google Scholar 2 : Prognostic significance of the 1997 TNM classification of renal cell carcinoma. J Urol1999; 162: 1277. Link, Google Scholar 3 : TNM staging alone is inadequate for predicting cancer-specific survival following radical nephrectomy for unilateral renal cell carcinoma. J Urol2001; 165: 185. abstract 768. Google Scholar 4 : Prognostic features of pathologic stage T1 renal cell carcinoma after radical nephrectomy. Urology2002; 59: 532. 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CAN ITS ACCURACY BE IMPROVED?Journal of Urology, VOL. 173, NO. 2, (380-384), Online publication date: 1-Feb-2005.LEIBOVICH B, CHEVILLE J, LOHSE C, ZINCKE H, KWON E, FRANK I, THOMPSON R and BLUTE M (2018) CANCER SPECIFIC SURVIVAL FOR PATIENTS WITH pT3 RENAL CELL CARCINOMA—CAN THE 2002 PRIMARY TUMOR CLASSIFICATION BE IMPROVED?Journal of Urology, VOL. 173, NO. 3, (716-719), Online publication date: 1-Mar-2005.FRANK I, BLUTE M, LEIBOVICH B, CHEVILLE J, LOHSE C and ZINCKE H (2018) INDEPENDENT VALIDATION OF THE 2002 AMERICAN JOINT COMMITTEE ON CANCER PRIMARY TUMOR CLASSIFICATION FOR RENAL CELL CARCINOMA USING A LARGE, SINGLE INSTITUTION COHORTJournal of Urology, VOL. 173, NO. 6, (1889-1892), Online publication date: 1-Jun-2005.GILLETT M, CHEVILLE J, KARNES R, LOHSE C, KWON E, LEIBOVICH B, ZINCKE H and BLUTE M (2018) COMPARISON OF PRESENTATION AND OUTCOME FOR PATIENTS 18 TO 40 AND 60 TO 70 YEARS OLD WITH SOLID RENAL MASSESJournal of Urology, VOL. 173, NO. 6, (1893-1896), Online publication date: 1-Jun-2005.LAM J, SHVARTS O, LEPPERT J, PANTUCK A, FIGLIN R and BELLDEGRUN A (2018) POSTOPERATIVE SURVEILLANCE PROTOCOL FOR PATIENTS WITH LOCALIZED AND LOCALLY ADVANCED RENAL CELL CARCINOMA BASED ON A VALIDATED PROGNOSTIC NOMOGRAM AND RISK GROUP STRATIFICATION SYSTEMJournal of Urology, VOL. 174, NO. 2, (466-472), Online publication date: 1-Aug-2005.LAM J, SHVARTS O, LEPPERT J, FIGLIN R and BELLDEGRUN A (2018) RENAL CELL CARCINOMA 2005: NEW FRONTIERS IN STAGING, PROGNOSTICATION AND TARGETED MOLECULAR THERAPYJournal of Urology, VOL. 173, NO. 6, (1853-1862), Online publication date: 1-Jun-2005.BONSIB S (2018) T2 CLEAR CELL RENAL CELL CARCINOMA IS A RARE ENTITY: A STUDY OF 120 CLEAR CELL RENAL CELL CARCINOMASJournal of Urology, VOL. 174, NO. 4 Part 1, (1199-1202), Online publication date: 1-Oct-2005.THOMPSON R, LEIBOVICH B, CHEVILLE J, WEBSTER W, LOHSE C, KWON E, FRANK I, ZINCKE H and BLUTE M (2018) IS RENAL SINUS FAT INVASION THE SAME AS PERINEPHRIC FAT INVASION FOR pT3a RENAL CELL CARCINOMA?Journal of Urology, VOL. 174, NO. 4 Part 1, (1218-1221), Online publication date: 1-Oct-2005.LEIBOVICH B, CHEVILLE J, LOHSE C, ZINCKE H, FRANK I, KWON E, MERCHAN J and BLUTE M (2018) A SCORING ALGORITHM TO PREDICT SURVIVAL FOR PATIENTS WITH METASTATIC CLEAR CELL RENAL CELL CARCINOMA: A STRATIFICATION TOOL FOR PROSPECTIVE CLINICAL TRIALSJournal of Urology, VOL. 174, NO. 5, (1759-1763), Online publication date: 1-Nov-2005. (2018) RE: RENAL VEIN OR INFERIOR VENA CAVAL EXTENSION IN PATIENTS WITH RENAL CORTICAL TUMORS: IMPACT OF TUMOR HISTOLOGY: Reply by AuthorsJournal of Urology, VOL. 172, NO. 3, (1196-1196), Online publication date: 1-Sep-2004.RICHSTONE L, SCHERR D, REUTER V, SNYDER M, RABBANI F, KATTAN M and RUSSO P (2018) Multifocal Renal Cortical Tumors: Frequency, Associated Clinicopathological Features and Impact on SurvivalJournal of Urology, VOL. 171, NO. 2, (615-620), Online publication date: 1-Feb-2004.RABBANI F, HAKIMIAN P, REUTER V, SIMMONS R and RUSSO P (2018) Renal Vein or Inferior Vena Caval Extension in Patients With Renal Cortical Tumors: Impact of Tumor HistologyJournal of Urology, VOL. 171, NO. 3, (1057-1061), Online publication date: 1-Mar-2004.Cheville J, Frank I, Leibovich B, Lohse C and Blute M (2018) RE: RENAL VEIN OR INFERIOR VENA CAVAL EXTENSION IN PATIENTS WITH RENAL CORTICAL TUMORS: IMPACT OF TUMOR HISTOLOGYJournal of Urology, VOL. 172, NO. 3, (1196-1196), Online publication date: 1-Sep-2004.PATARD J, LERAY E, CINDOLO L, FICARRA V, RODRIGUEZ A, DE LA TAILLE A, TOSTAIN J, ARTIBANI W, ABBOU C, GUILLÉ F, CHOPIN D and LOBEL B (2018) MULTI-INSTITUTIONAL VALIDATION OF A SYMPTOM BASED CLASSIFICATION FOR RENAL CELL CARCINOMAJournal of Urology, VOL. 172, NO. 3, (858-862), Online publication date: 1-Sep-2004.PATARD J, DOREY F, CINDOLO L, FICARRA V, DE LA TAILLE A, TOSTAIN J, ARTIBANI W, ABBOU C, LOBEL B, CHOPIN D, FIGLIN R, BELLDEGRUN A and PANTUCK A (2018) SYMPTOMS AS WELL AS TUMOR SIZE PROVIDE PROGNOSTIC INFORMATION ON PATIENTS WITH LOCALIZED RENAL TUMORSJournal of Urology, VOL. 172, NO. 6 Part 1, (2167-2171), Online publication date: 1-Dec-2004. (2018) EDITORIAL COMMENTJournal of Urology, VOL. 169, NO. 3, (903-904), Online publication date: 1-Mar-2003.PARKER A, CHEVILLE J, LOHSE C, CERHAN J and BLUTE M (2018) Expression of Insulin-like Growth Factor I Receptor and Survival in Patients with Clear Cell Renal Cell CarcinomaJournal of Urology, VOL. 170, NO. 2, (420-424), Online publication date: 1-Aug-2003.FRANK I, BLUTE M, CHEVILLE J, LOHSE C, WEAVER A and ZINCKE H (2018) Solid Renal Tumors: An Analysis of Pathological Features Related to Tumor SizeJournal of Urology, VOL. 170, NO. 6, (2217-2220), Online publication date: 1-Dec-2003.FRANK I, BLUTE M, CHEVILLE J, LOHSE C, WEAVER A, LEIBOVICH B and ZINCKE H (2018) A Multifactorial Postoperative Surveillance Model for Patients With Surgically Treated Clear Cell Renal Cell CarcinomaJournal of Urology, VOL. 170, NO. 6, (2225-2232), Online publication date: 1-Dec-2003.HAN K, BLEUMER I, PANTUCK A, KIM H, DOREY F, JANZEN N, ZISMAN A, DINNEY C, WOOD C, SWANSON D, SAID J, FIGLIN R, MULDERS P and BELLDEGRUN A (2018) Validation of an Integrated Staging System Toward Improved Prognostication of Patients With Localized Renal Cell Carcinoma in an International PopulationJournal of Urology, VOL. 170, NO. 6, (2221-2224), Online publication date: 1-Dec-2003. Volume 168Issue 6December 2002Page: 2395-2400 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordstreatment outcome, survival, nephrectomycarcinoma, renal cellMetricsAuthor Information IGOR FRANK More articles by this author MICHAEL L. BLUTE More articles by this author JOHN C. CHEVILLE More articles by this author CHRISTINE M. LOHSE More articles by this author AMY L. WEAVER More articles by this author HORST ZINCKE More articles by this author Expand All Advertisement PDF downloadLoading ...