Improved prognostication of renal cell carcinoma using an integrated staging system
Improved prognostication of renal cell carcinoma using an integrated staging system
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DOI：
10.1200/jco.2001.19.6.1649
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发表时间：
2001-03-15
影响因子：
45.3
通讯作者：
Belldegrun, AS
中科院分区：
文献类型：
--
作者：
Zisman, A;Pantuck, AJ;Belldegrun, AS
目的：将肾细胞癌(RCC)患者的分期、分级和东协力肿瘤学小组(ECOG)的表现状态(PS)整合为一个临床上有用的评估肾细胞癌(RCC)患者生存状况的指标。中位年龄61岁，男女比例为2：2：1，中位随访时间37个月。生存时间是评估的主要终点。分析了64种可能的阶段、等级和ECOG P组合，并将其归入不同的组。结果：将1997年肿瘤转移分期、Fuhrman分级和ECOG PS进行组合和分层，得到五个生存分层组，命名为UISS，编号为I到V。UISS组的2年和5年生存率预测如下：1、96%和94%；II、89%和67%；III、66%和39%；IV、42%和23%；V分别为9%和0%。结论：结合临床变量提供了一种新的肾癌分期和预后预测系统。UISS使用简单，在区分患者生存方面优于单独的STAGE。我们的数据表明，UISS是咨询不同阶段肾癌患者的重要预后工具。进一步的预期大规模外部数据验证正在等待中。(C)2001年，由美国临床肿瘤学会主办。
Purpose: To integrate stage, grade, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) into a clinically useful fool capable of stratifying the survival of renal cell carcinoma (RCC) patients.Patients and Methods: The medical records of 661 patients undergoing nephrectomy at University of California Los Angeles between 1989 and 1999 were evaluated. Median age was 61 years, male-to-female ratio was 2:2:1, and median follow-up was 37 months. Survival time was the primary end point assessed. Sixty-four possible combinations of stage, grade, and ECOG PS were analyzed and collapsed into distinct groups. The infernal validity of the categoriesd was challenged by a univariate analysis and a multivariate analysis testing for the accountability of each UCLA Integrated Staging System (UISS) category against independent variables shown to have impact on survival.Results: Combining and stratifying 1997-tumor-node-metastasis stage, Fuhrman's grade and ECOG PS resulted in five survival stratification groups designated UISS, and numbered I to V. The projected 2- and 5-year survival for the UISS groups are as follows for the groups: 1, 96% and 94%; II, 89% and 67%; III, 66% and 39%; IV, 42% and 23%; and V,9% and 0%, respectively. UISS accounted for the significant variables in the variate analysis.Conclusion: A novel system for staging and predicting survival for RCC integrating clinical variables is offered. UISS is simple to use and is superior to stage alone in differentiating patients' survival. Our data suggests that UISS is an important prognostic tool for counseling patients with various stages of kidney cancer. Further prospective large-scale validation with external data is awaited. (C) 2001 by American Society of Clinical Oncology.