Prognostic Significance of Grade Discrepancy Between Primary Tumor and Venous Thrombus in Nonmetastatic Clear-cell Renal Cell Carcinoma: Analysis of the REMEMBER Registry and Implications for Adjuvant Therapy

Further stratification of the risk of recurrence of clear-cell renal cell carcinoma (ccRCC) with venous tumor thrombus (VTT) will facilitate selection of candidates for adjuvant therapy. To assess the impact of tumor grade discrepancy (GD) between the primary tumor (PT) and VTT in nonmetastatic ccRCC on disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS). This was a retrospective analysis of a multi-institutional nationwide data set for patients with pT3N0M0 ccRCC who underwent radical nephrectomy and thrombectomy. Pathology slides were centrally reviewed. GD, a bidirectional variable (upgrading or downgrading), was numerically defined as the VTT grade minus the PT grade. Multivariable models were built to predict DFS, OS, and CSS. We analyzed data for 604 patients with median follow-up of 42 mo (excluding events). Tumor GD between VTT and PT was observed for 47% (285/604) of the patients and was an independent risk factor with incremental value in predicting the outcomes of interest (all p < 0.05). Incorporation of tumor GD significantly improved the performance of the ECOG-ACRIN 2805 (ASSURE) model. A GD-based model (PT grade, GD, pT stage, PT sarcomatoid features, fat invasion, and VTT consistency) had a c index of 0.72 for DFS. The hazard ratios were 8.0 for GD = +2 (p < 0.001), 1.9 for GD = +1 (p < 0.001), 0.57 for GD = −1 (p = 0.001), and 0.22 for GD = −2 (p = 0.003) versus GD = 0 as the reference. According to model-converted risk scores, DFS, OS, and CSS significantly differed between subgroups with low, intermediate, and high risk (all p < 0.001). Routine reporting of VTT upgrading or downgrading in relation to the PT and use of our GD-based nomograms can facilitate more informed treatment decisions by tailoring strategies to an individual patient's risk of progression. We developed a tool to improve patient counseling and guide decision-making on other therapies in addition to surgery for patients with the clear-cell type of kidney cancer and tumor invasion of a vein.

Авторы
Wu Zhenjie1, 2 , Chen Hui3 , Chen Qi4 , Ge Silun5 , Yu Nengwang6 , Campi Riccardo2, 7, 8 , Gómez Rivas Juan9 , Autorino Riccardo 10 , Rouprêt Morgan11 , Psutka S.P.12 , Mehrazin Reza13 , Porpiglia Francesco14 , Bensalah Karim15 , Black P.C.16 , Mir M.C. 17, 18, 19 , Minervini Andrea20 , Djaladat Hooman21 , Margulis Vitaly22 , Bertolo Riccardo2, 23 , Caliò Anna2, 24 , Carbonara Umberto , Amparore Daniele , Borregales L.D. , Ciccarese Chiara , Diana Pietro , Erdem Selcuk , Marandino Laura , Marchioni Michele , Muselaers C.H. , Palumbo Carlotta , Pavan Nicola , Pecoraro Angela , Roussel Eduard , Warren Hannah , Pandolfo S.D. , Chen Rui4 , Zhou Wenquan , Zhai Wei , He Miaoxia4 , Li Yaoming2, 24 , Han Bo , Wan Jie6 , Zeng Xing , Yan Junan , Fu Yao , Ji Changwei1, 2 , Fan Xiang , Zhang Guangyuan , Zhao Cheng , Jing Taile , Wang Anbang6 , Feng Chenchen , Zhao Hongwei , Sun Di , Wang Liang6 , Tai Sheng , Zhang Cheng , Chen Shaohao4 , Liu Yixun , Xu Zhipeng , Wang Haifeng6 , Gao Jinli , Wang Fubo6 , Cheng Jiwen , Miao He4 , Rao Qiu , Wang Jianning6 , Xu Ning , Wang Gongxian6 , Liang Chaozhao , Liu Zhiyu , Xia Dan , Jiang Jun , Zu Xiongbing , Chen Ming4 , Guo Hongqian , Qin Weijun , Wang Zhe6 , Xue Wei , Shi Benkang , Zhou Xiaojun , Wang Shaogang6 , Zheng Junhua , Ge Jingping5 , Feng Xiang , Li Minming2, 24 , Chen Cheng 4 , Qu Le , Wang Linhui6
Издательство
ELSEVIER SCIENCE BV, PO BOX 211, AMSTERDAM, NETHERLANDS, 1000 AE
Номер выпуска
1
Язык
Английский
Страницы
112-121
Статус
Опубликовано
Том
7
Год
2024
Организации
  • 1 Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
  • 2 European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands
  • 3 Department of Pathology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China
  • 4 Department of Health Statistics, Naval Medical University, Shanghai, China
  • 5 Department of Urology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China
  • 6 Department of Urology, Qilu Hospital, Shandong University, Jinan, China
  • 7 Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
  • 8 Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
  • 9 Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
  • 10 Department of Urology, Rush University Medical Center, Chicago, IL, USA
  • 11 Department of Urology, GRC No. 5, Predictive ONCO-URO, Hospital Pitié-Salpêtrière, AP-HP, Sorbonne University, Paris, France
  • 12 Department of Urology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA
  • 13 Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  • 14 Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
  • 15 Department of Urology, University of Rennes, Rennes, France
  • 16 Department of Urologic Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
  • 17 Department of Urology
  • 18 Hospital Universitario La Ribera
  • 19 Valencia, Spain
  • 20 Departments of Urology and Experimental and Clinical Medicine, University of Florence, Florence, Italy
  • 21 Institute of Urology, University of Southern California, Los Angeles, CA, USA
  • 22 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
  • 23 Urology Unit, San Carlo di Nancy Hospital, Rome, Italy
  • 24 Department of Diagnostic and Public Health, University of Verona, Verona, Italy
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