Predicting Recurrence After Radical Surgery for High-Risk Renal Cell Carcinoma: Development and Internal Validation of the "TOWARDS" Score.
Adjuvant therapy
High risk
Kidney cancer
Recurrence
Risk score
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
29 Jan 2024
29 Jan 2024
Historique:
received:
29
09
2023
accepted:
10
01
2024
medline:
29
1
2024
pubmed:
29
1
2024
entrez:
29
1
2024
Statut:
aheadofprint
Résumé
Considering the reported greater benefits of immunotherapy and its unignorable adverse events in adjuvant therapy for high-risk renal cell carcinoma (hrRCC), accurate prediction may optimize drug use. The primary objective of this study was to generate a score-based prognostic model of recurrence-free survival in hrRCC. The study retrospectively evaluated 456 patients at two institutions who underwent radical surgery for nonmetastatic pT3-4 and/or N1-2 or pT2 and G4 disease. Clinical variables deemed universally available were selected through backward stepwise analysis and fitted by a multivariable Cox proportional hazards regression model. A point-based score was derived from regression coefficients. Discrimination, calibration, and decision curve analyses were conducted to evaluate predictive performance. Internal validation with bootstrapping was performed to correct for optimism. The mean follow-up period was 55.3 months, and the median follow-up period was 28.0 months. During the follow-up period, the recurrence rate was 48.2% (n = 220) during a median of 75.7 months. Stepwise variable selection retained age, Eastern Cooperative Oncology Group (ECOG) performance status, presence or absence of symptoms, size of the primary tumor, pathologic T stage, pathologic N stage, tumor grade, and histology. Subsequently, the TOWARDS score (range 0-53) was developed from these variables. Internal validation showed an optimism-corrected C-index of 0.723 and a calibration slope of 0.834. The decision curve analysis showed the superiority of this score over the University of California, Los Angeles (UCLA) Integrated Staging System and GRade, Age, Nodes, and Tumor score. The authors' novel TOWARDS scoring model had good accuracy for predicting disease recurrence in patients with hrRCC, and the clinical practicability was superior to that of the existing models.
Sections du résumé
BACKGROUND
BACKGROUND
Considering the reported greater benefits of immunotherapy and its unignorable adverse events in adjuvant therapy for high-risk renal cell carcinoma (hrRCC), accurate prediction may optimize drug use.
METHODS
METHODS
The primary objective of this study was to generate a score-based prognostic model of recurrence-free survival in hrRCC. The study retrospectively evaluated 456 patients at two institutions who underwent radical surgery for nonmetastatic pT3-4 and/or N1-2 or pT2 and G4 disease. Clinical variables deemed universally available were selected through backward stepwise analysis and fitted by a multivariable Cox proportional hazards regression model. A point-based score was derived from regression coefficients. Discrimination, calibration, and decision curve analyses were conducted to evaluate predictive performance. Internal validation with bootstrapping was performed to correct for optimism.
RESULTS
RESULTS
The mean follow-up period was 55.3 months, and the median follow-up period was 28.0 months. During the follow-up period, the recurrence rate was 48.2% (n = 220) during a median of 75.7 months. Stepwise variable selection retained age, Eastern Cooperative Oncology Group (ECOG) performance status, presence or absence of symptoms, size of the primary tumor, pathologic T stage, pathologic N stage, tumor grade, and histology. Subsequently, the TOWARDS score (range 0-53) was developed from these variables. Internal validation showed an optimism-corrected C-index of 0.723 and a calibration slope of 0.834. The decision curve analysis showed the superiority of this score over the University of California, Los Angeles (UCLA) Integrated Staging System and GRade, Age, Nodes, and Tumor score.
CONCLUSIONS
CONCLUSIONS
The authors' novel TOWARDS scoring model had good accuracy for predicting disease recurrence in patients with hrRCC, and the clinical practicability was superior to that of the existing models.
Identifiants
pubmed: 38285306
doi: 10.1245/s10434-024-14963-0
pii: 10.1245/s10434-024-14963-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. Society of Surgical Oncology.
Références
Bedke J, Albiges L, Capitanio U, et al. The 2021 Updated European Association of Urology guidelines on renal cell carcinoma: immune checkpoint inhibitor-based combination therapies for treatment-naïve metastatic clear-cell renal cell carcinoma are standard of care. Eur Urol. 2021;80:393–7.
doi: 10.1016/j.eururo.2021.04.042
pubmed: 34074559
Karakiewicz PI, Briganti A, Chun FK, et al. Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol. 2007;25:1316–22.
doi: 10.1200/JCO.2006.06.1218
pubmed: 17416852
Leibovich BC, Blute ML, Cheville JC, et al. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer. 2003;97:1663–71.
doi: 10.1002/cncr.11234
pubmed: 12655523
Marconi L, Sun M, Beisland C, et al. Prevalence, disease-free, and overall survival of contemporary patients with renal cell carcinoma eligible for adjuvant checkpoint inhibitor trials. Clin Genitourin Cancer. 2021;19:e92–9.
doi: 10.1016/j.clgc.2020.12.005
pubmed: 33526329
Powles T, Tomczak P, Park SH, et al. Pembrolizumab versus placebo as post-nephrectomy adjuvant therapy for clear cell renal cell carcinoma (KEYNOTE-564): 30-month follow-up analysis of a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2022;23:1133–44.
doi: 10.1016/S1470-2045(22)00487-9
pubmed: 36055304
Abel EJ, Masterson TA, Karam JA, et al. Predictive nomogram for recurrence following surgery for nonmetastatic renal cell cancer with tumor thrombus. J Urol. 2017;198:810–6.
doi: 10.1016/j.juro.2017.04.066
pubmed: 28411071
Kattan MW, Reuter V, Motzer RJ, Katz J, Russo P. A postoperative prognostic nomogram for renal cell carcinoma. J Urol. 2001;166:63–7.
doi: 10.1016/S0022-5347(05)66077-6
pubmed: 11435824
Correa AF, Jegede OA, Haas NB, et al. Predicting disease recurrence, early progression, and overall survival following surgical resection for high-risk localized and locally advanced renal cell carcinoma. Eur Urol. 2021;80:20–31.
doi: 10.1016/j.eururo.2021.02.025
pubmed: 33707112
Zisman A, Pantuck AJ, Dorey F, et al. Improved prognostication of renal cell carcinoma using an integrated staging system. J Clin Oncol. 2001;19:1649–57.
doi: 10.1200/JCO.2001.19.6.1649
pubmed: 11250993
Buti S, Puligandla M, Bersanelli M, et al. Validation of a new prognostic model to easily predict outcome in renal cell carcinoma: the GRANT score applied to the ASSURE trial population. Ann Oncol. 2017;28:2747–53.
doi: 10.1093/annonc/mdx492
pubmed: 28945839
Moons KG, Altman DG, Reitsma JB, et al. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med. 2015;162:W1-73.
doi: 10.7326/M14-0698
pubmed: 25560730
Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. Wiley, Hoboken, NJ; 2017.
Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982;6:655–63.
doi: 10.1097/00000478-198210000-00007
pubmed: 7180965
Delahunt B, Cheville JC, Martignoni G, et al. The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters. Am J Surg Pathol. 2013;37:1490–504.
doi: 10.1097/PAS.0b013e318299f0fb
pubmed: 24025520
Gregg J, Scarpato K. Surgical approaches for open renal surgery, including open radical nephrectomy. In: Hinman’s Atlas of urologic surgery. 4th ed. Elsevier, Philadelphia, PA, 2018.
Orden M, Landman J. Laparoscopic nephrectomy. In: Hinman’s Atlas of urologic surgery. 4 ed. Elsevier, Philadelphia, PA, 2018.
Bonnett LJ, Snell KIE, Collins GS, Riley RD. Guide to presenting clinical prediction models for use in clinical settings. BMJ. 2019;365:l737.
doi: 10.1136/bmj.l737
pubmed: 30995987
Sullivan LM, Massaro JM, D’Agostino RB Sr. Presentation of multivariate data for clinical use: the Framingham Study risk score functions. Stat Med. 2004;23:1631–60.
doi: 10.1002/sim.1742
pubmed: 15122742
Palumbo C, Perri D, Zacchero M, et al. Risk of recurrence after nephrectomy: comparison of predictive ability of validated risk models. Urol Oncol. 2022;40(167):e161–7.
Leibovich BC, Lohse CM, Cheville JC, et al. Predicting oncologic outcomes in renal cell carcinoma after surgery. Eur Urol. 2018;73:772–80.
doi: 10.1016/j.eururo.2018.01.005
pubmed: 29398265
Capitanio U, Bedke J, Albiges L, et al. A renewal of the TNM staging system for patients with renal cancer to comply with current decision-making: proposal from the European Association of Urology Guidelines Panel. Eur Urol. 2023;83:3–5.
doi: 10.1016/j.eururo.2022.09.026
pubmed: 36253306
Lam JS, Klatte T, Patard JJ, et al. Prognostic relevance of tumour size in T3a renal cell carcinoma: a multicentre experience. Eur Urol. 2007;52:155–62.
doi: 10.1016/j.eururo.2007.01.106
pubmed: 17316970
Novara G, Ficarra V, Antonelli A, et al. Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: are further improvements needed? Eur Urol. 2010;58:588–95.
doi: 10.1016/j.eururo.2010.07.006
pubmed: 20674150
Haas NB, Manola J, Uzzo RG, et al. Adjuvant sunitinib or sorafenib for high-risk, non-metastatic renal-cell carcinoma (ECOG-ACRIN E2805): a double-blind, placebo-controlled, randomised, phase 3 trial. Lancet. 2016;387:2008–16.
doi: 10.1016/S0140-6736(16)00559-6
pubmed: 26969090
Klatte T, Rossi SH, Stewart GD. Prognostic factors and prognostic models for renal cell carcinoma: a literature review. World J Urol. 2018;36:1943–52.
doi: 10.1007/s00345-018-2309-4
pubmed: 29713755
Tran J, Ornstein MC. Clinical review on the management of metastatic renal cell carcinoma. JCO Oncol Pract. 2022;18(3):187–96.
doi: 10.1200/OP.21.00419
pubmed: 34529499