Staging system for renal cell carcinoma is reliable, reproducible

Chicago-A staging system that accounts for interactions among tumor stage and grade and patient performance status offers a reliable and reproducible means for predicting mortality after surgery for renal cell carcinoma, investigators reported here.

Survival decreased in a linear fashion as the staging system-derived level of patient risk increased. The association remained intact for follow-up at 5, 10, and 15 years, and the system accurately projected survival for patients with localized or metastatic kidney cancer, according to a presentation at the American Society of Clinical Oncology annual meeting.

"[The staging system] is a highly reliable and reproducible predictor of mortality following nephrectomy for localized and metastatic renal cell carcinoma, allowing personal tailoring for treatments, as well as allocation into clinical trials," concluded Stephen B. Riggs, MD, and colleagues at the UCLA Medical Center, Los Angeles. "Surveillance and personal treatments should be individualized for a particular patient around risk group categorization following surgery for their primary tumor."

The system is able to identify patients with different mortality risks after nephrectomy by stratifying individuals into one of three risk groups (low, intermediate, and high) for localized and metastatic RCC, according to Dr. Riggs, a urologic oncology fellow at UCLA, who worked with senior investigator Arie Belldegrun, MD, and colleagues.

In the current study, the S&P-UISS was applied to the outcomes of 1,492 patients who underwent partial or radical nephrectomy at UCLA and who had a final histologic determination of RCC. For both localized and metastatic RCC, survival decreased with increasing risk category. For example, in the non-metastatic group, low-risk patients had a 5-year disease-specific survival of 97% compared with 81% for intermediate-risk and 62% for the high-risk patients.

On the basis of a concordance analysis, the S&P-UISS more accurately predicted disease-specific survival than did the TNM staging system.

The S&P-UISS fits well with evolutionary approaches to managing RCC, the investigators noted. RCC is a heterogeneous disease with respect to biology, clinical manifestations, and outcome. Better understanding of prognostic factors associated with RCC is leading to individualized surveillance and treatment, which depend on accurate risk assessment.