Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Brookman-May, S; May, M; Shariat, SF; Xylinas, E; Stief, C; Zigeuner, R; Chromecki, T; Burger, M; Wieland, WF; Cindolo, L; Schips, L; De Cobelli, O; Rocco, B; De Nunzio, C; Feciche, B; Truss, M; Gilfrich, C; Pahernik, S; Hohenfellner, M; Zastrow, S; Wirth, MP; Novara, G; Carini, M; Minervini, A; Simeone, C; Antonelli, A; Mirone, V; Longo, N; Simonato, A; Carmignani, G; Ficarra, V; Members of the CORONA project and the SATURN project.
Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN Project).
Eur Urol. 2013; 64(3):472-477
Doi: 10.1016/j.eururo.2012.06.030
Web of Science
PubMed
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- Co-Autor*innen der Med Uni Graz
- Chromecki Thomas
- Zigeuner Richard
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- Abstract:
- Background: Approximately 10-20% of recurrences in patients treated with nephrectomy for renal cell carcinoma (RCC) develop beyond 5 yr after surgery (late recurrence). Objective: To determine features associated with late recurrence. Design, setting, and participants: A total of 5009 patients from a multicenter database comprising 13 107 RCC patients treated surgically had a minimum recurrence-free survival of 60 mo (median follow-up [FU]: 105 mo [range: 78-135]); at last FU, 4699 were disease free (median FU: 103 mo [range: 78-134]), and 310 patients (6.2%) experienced disease recurrence (median FU: 120 mo [range: 93-149]). Interventions: Patients underwent radical nephrectomy or nephron-sparing surgery. Outcome measurements and statistical analysis: Multivariable regression analyses identified features associated with late recurrence. Cox regression analyses evaluated the association of features with cancer-specific mortality (CSM). Results and limitations: Lymphovascular invasion (LVI) (odds ratio [OR]: 3.07; p < 0.001), Fuhrman grade 3-4 (OR: 1.60; p = 0.001), and pT stage >pT1 (OR: 2.28; p < 0.001) were significantly associated with late recurrence. Based on accordant regression coefficients, these parameters were weighted with point values (LVI: 2 points; Fuhrman grade 3-4: 1 point, pT stage >1: 2 points), and a risk score was developed for the prediction of late recurrences. The calculated values (0 points: late recurrence risk 3.1%; 1-3 points: 8.4%; 4-5 points: 22.1%) resulted in a good-, intermediate-and poor-prognosis group(area under the curve value for the model: 70%; 95% confidence interval, 67-73). Multivariable Cox regression analysis showed LVI (HR: 2.75; p < 0.001), pT stage (HR: 1.24; p < 0.001), Fuhrman grade (HR: 2.40; p < 0.001), age (HR: 1.01; p < 0.001), and gender (HR: 0.71; p = 0.027) to influence CSM significantly. Limitations are based on the multicenter and retrospective study design. Conclusions: LVI, Fuhrman grade 3/4, and a tumor stage>pT1 are independent predictors of late recurrence after at least 5 yr from surgery in patients with RCC. We developed a risk score that allows for prognostic stratification and individualized aftercare of patients with regard to counseling, follow-up scheduling, and clinical trial design. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.
- Find related publications in this database (using NLM MeSH Indexing)
- Aged -
- Carcinoma, Renal Cell - mortality
- Chi-Square Distribution -
- Databases, Factual -
- Decision Support Techniques -
- Disease-Free Survival -
- Female -
- Humans -
- Kidney Neoplasms - mortality
- Logistic Models -
- Lymphatic Metastasis -
- Male -
- Middle Aged -
- Multivariate Analysis -
- Neoplasm Grading -
- Neoplasm Recurrence, Local -
- Neoplasm Staging -
- Nephrectomy - adverse effects
- Odds Ratio -
- Predictive Value of Tests -
- Proportional Hazards Models -
- Reproducibility of Results -
- Retrospective Studies -
- Risk Assessment -
- Risk Factors -
- Time Factors -
- Treatment Outcome -
- Find related publications in this database (Keywords)
- Renal cell carcinoma
- Late recurrence
- Prognostic parameters
- Risk score
- Cancer-specific mortality
- Nephrectomy