Improved Prognostication of Renal Cell Carcinoma Using an Integrated Staging System

作者：Amnon Zisman, Allan J. Pantuck, FREDRICK J. DOREY, JONATHAN W. SAID, Oleg Shvarts, Deanna Quintana, Barbara Jennifer Gitlitz, Jean B. deKernion, Robert A. Figlin, Arie S. Belldegrun · 发表于：Journal of Clinical Oncology · 年份：2001 · DOI：10.1200/jco.2001.19.6.1649 · 被引用次数：736 · 研究领域：Renal cell carcinoma treatment、Bladder and Urothelial Cancer Treatments、Multiple and Secondary Primary Cancers

PURPOSE: To integrate stage, grade, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) into a clinically useful tool capable of stratifying the survival of renal cell carcinoma (RCC) patients. PATIENTS AND METHODS: The medical records of 661 patients undergoing nephrectomy at University of California Los Angeles between 1989 and 1999 were evaluated. Median age was 61 years, male-to-female ratio was 2.2:1, and median follow-up was 37 months. Survival time was the primary end point assessed. Sixty-four possible combinations of stage, grade, and ECOG PS were analyzed and collapsed into distinct groups. The internal validity of the categorized was challenged by a univariate analysis and a multivariate analysis testing for the accountability of each UCLA Integrated Staging System (UISS) category against independent variables shown to have impact on survival. RESULTS: Combining and stratifying 1997 tumor-node-metastasis stage, Fuhrman's grade and ECOG PS resulted in five survival stratification groups designated UISS, and numbered I to V. The projected 2- and 5-year survival for the UISS groups are as follows for the groups: I, 96% and 94%; II, 89% and 67%; III, 66% and 39%; IV, 42% and 23%; and V, 9% and 0%, respectively. UISS accounted for the significant variables in the variate analysis. CONCLUSION: A novel system for staging and predicting survival for RCC integrating clinical variables is offered. UISS is simple to use and is superior to stage alone in diff...