Validation of an integrated staging system toward improved prognostication of patients with localized renal cell carcinoma in an international population
Validation of an integrated staging system toward improved prognostication of patients with localized renal cell carcinoma in an international population
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DOI：
10.1097/01.ju.0000096049.64863.a1
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发表时间：
2003-12-01
影响因子：
6.6
通讯作者：
Belldegrun, AS
中科院分区：
文献类型：
--
作者：
Han, KR;Bleumer, I;Belldegrun, AS
目的：肾细胞癌患者的预后预测是基于多种因素的组合。在这项研究中，使用国际数据库验证了先前发表的基于1997年T分期、Fuhrman分级和性能评分的临床结局算法。来自荷兰奈梅亨（NN）、MD安德森（MDA）和加州大学的共计1,060名患者，洛杉矶（UCLA）的肾细胞癌患者进行了结果预测评估，中、高危人群。通过比较3个中心内的3个风险组分别进行验证，以及通过比较3 centers.Results之间的风险比和一致性指数：估计的疾病特异性生存率在5年的低风险组分别为94%（NN），92%（MDA）和93%（UCLA）。中危组的5年疾病特异性生存率分别为65%（NN）、73%（MDA）和78%（UCLA），而高危组的5年疾病特异性生存率分别为40%（NN）、30%（MDA）和48%（UCLA）。每个数据库的一致性指数分别为79%（NN），86%（MDA）和84%（UCLA）。结论：临床算法，仅使用3个预后变量（1997年T分期，Fuhrman分级和性能状态），以分层局部肾细胞癌患者分为3个风险组已被证明是适用于外部数据库。该算法可用于患者咨询、监测和识别高风险患者以供临床试验招募。
Purpose: Outcome prediction for patients with renal cell carcinoma is based on a combination of factors. In this study a previously published clinical outcome algorithm based on 1997 T stage, Fuhrman grade and performance score is validated using an international database.Materials and Methods: A total of 1,060 patients from Nijmegen, the Netherlands (NN), MD Anderson (MDA) and University of California, Los Angeles (UCLA) who had localized renal cell carcinoma were evaluated for outcome prediction using a clinical outcome algorithm previously shown to stratify patients into low, intermediate and high risk groups. Validation was performed by comparing the 3 risk groups separately within the 3 centers as well as by comparing hazard ratios and concordance indices among the 3 centers.Results: Estimated disease specific survival rates at 5 years for the low risk groups were 94% (NN), 92% (MDA) and 93% (UCLA). The 5-year disease specific survival rates for the intermediate risk groups were 65% (NN), 73% (MDA) and 78% (UCLA), while the rates for the high risk groups were 40% (NN), 30% (MDA) and 48% (UCLA). The concordance indices for each of the databases were 79% (NN), 86% (MDA) and 84% (UCLA).Conclusions: A clinical algorithm that uses only 3 prognostic variables (1997 T stage, Fuhrman grade and performance status) to stratify patients with localized renal cell carcinoma into 3 risk groups has been shown to be applicable to external databases. This algorithm may be useful for patient counseling, surveillance and identification of high risk patients for enrollment in clinical trials.