The SSPN Score, a Novel Scoring System Incorporating PBRM1 Expression, Predicts Postoperative Recurrence for Patients with Non-metastatic Clear Cell Renal Cell Carcinoma
The SSPN Score, a Novel Scoring System Incorporating PBRM1 Expression, Predicts Postoperative Recurrence for Patients with Non-metastatic Clear Cell Renal Cell Carcinoma
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DOI：
10.1245/s10434-020-09075-4
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发表时间：
2020-09-17
影响因子：
3.7
通讯作者：
Matsuda, Tadashi
中科院分区：
文献类型：
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作者：
Ohsugi, Haruyuki;Yoshida, Takashi;Matsuda, Tadashi
PBRM 1表达的缺失（通过免疫组织化学鉴定）与肾透明细胞癌（ccRCC）患者术后复发的高风险相关。作者开发了一个评分系统，以预测复发的基础上，纳入PBRM 1表达的临床病理因素。方法回顾性分析2006年至2017年间479例ccRCC患者的根治性手术。该研究提取了389名非转移性ccRCC患者的子集，这些患者的相关临床病理因素可用。主要终点是无复发生存期（RFS）。采用Kaplan-Meier法和考克斯比例风险模型进行统计分析。Leibovich评分、SSIGN评分和加州大学洛杉矶分校（UCLA）综合分期系统被包括作为常规预测模型。结果389例患者中，53例（13.6%）在中位61个月内复发。多变量分析显示RFS的独立因素为>= pT 3（风险比[HR] 3.64;P < 0.001）、肉瘤样或横纹肌样成分（HR 3.29;P = 0.005）、PBRM 1阴性（HR 3.39;P = 0.001）和坏死（HR 3.60;P < 0.001）。用这些因素计算的评分系统，即SSPN（分期、肉瘤样、PBRM 1表达和坏死）评分，显示以下四组的RFS差异有统计学意义;低危组（0个因素）、中危组（1个因素）、高危组（2至3个因素）和极高危组（4个因素）（P < 0.001）。作者的模型还显示了比传统模型更高的5年RFS预测准确性（0.841 vs 0.747-0.792）。结论SSPN评分结合临床病理特征和PBRM 1表达，可准确预测非转移性ccRCC患者根治术后复发。
Background The loss of PBRM1 expression (as identified by immunohistochemistry) is associated with a high risk of postoperative recurrence for patients with clear cell renal cell carcinoma (ccRCC). The authors developed a scoring system to predict recurrence based on clinicopathologic factors incorporating PBRM1 expression. Methods This study retrospectively reviewed 479 ccRCC patients who underwent radical surgery between 2006 and 2017. The study extracted a subset of 389 non-metastatic ccRCC patients for whom relevant clinicopathologic factors were available. The primary end point was recurrence-free survival (RFS). The Kaplan-Meier method and the Cox proportional hazards model were used for statistical analysis. Leibovich score, SSIGN score, and University of California, Los Angeles (UCLA) Integrated Staging System were included as conventional prediction models. Results Of the 389 patients, 53 (13.6%) experienced recurrence during a median period of 61 months. Multivariable analyses showed that that the independent factors for RFS were >= pT3 (hazard ratio [HR] 3.64;P < 0.001), sarcomatoid or rhabdoid component (HR 3.29;P = 0.005), PBRM1 negativity (HR 3.39;P = 0.001), and necrosis (HR 3.60;P < 0.001). A scoring system calculated with these factors, named the SSPN (stage,sarcomatoid, PBRM1 expression, and necrosis) score, showed significant differences in RFS among the following four groups; low-risk group (0 factors), intermediate-risk group (1 factor), high-risk group (2 to 3 factors), and very high-risk group (4 factors) (P < 0.001). The authors' model also showed a greater predictive accuracy for 5-year RFS than the conventional models (0.841 vs 0.747-0.792). Conclusions The SSPN score, which integrates clinicopathologic findings and PBRM1 expression, can accurately predict postoperative recurrence for patients with non-metastatic ccRCC after radical surgery.