A scoring algorithm to predict survival for patients with metastatic clear cell renal cell carcinoma: A stratification tool for prospective clinical trials
A scoring algorithm to predict survival for patients with metastatic clear cell renal cell carcinoma: A stratification tool for prospective clinical trials
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DOI：
10.1097/01.ju.0000177487.64651.3a
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发表时间：
2005-11-01
影响因子：
6.6
通讯作者：
Blute, ML
中科院分区：
文献类型：
--
作者：
Leibovich, BC;Cheville, JC;Blute, ML
目的：我们开发了一种临床有用的评分算法来预测透明细胞转移性肾细胞癌（RCC）患者的癌症特异性生存。材料和方法：从1970年到2000年，我们研究了727例接受根治性肾切除术治疗的透明细胞癌患者，其中285例在肾切除术时远处转移或随后发生转移（442例）。利用Cox比例风险模型的回归系数，开发了一种预测癌症特异性生存的评分算法。结果：606例透明细胞RCC患者在转移性RCC后中位1.0年（范围0 - 14年）死亡。肾切除术时的体格症状（+2）、骨转移（+2）或肝转移（+4）、多处同时转移（+2）、肾切除术时转移（+1）或肾切除术后2年内转移（+3）、所有转移部位完全切除（-5）、肿瘤血栓I至IV级（+3）、核4级（+3）和组织学肿瘤坏死（+2）的主要病理特征与肾细胞癌死亡显著相关。所有患者开始时得分为0分，并按括号中所示进行加分或减分。评分为-5 ~ -1分、0 ~ 2分、3 ~ 6分、7 ~ 8分、9分及以上的患者，1年肿瘤特异性生存率分别为85.1%、72.1%、58.8%、39.0%和25.1%。结论：该评分算法可用于预测转移性透明细胞RCC患者的癌症特异性生存。
Purpose: We developed a clinically useful scoring algorithm to predict cancer specific survival for patients with clear cell metastatic renal cell carcinoma (RCC).Materials and Methods: We studied 727 patients treated with radical nephrectomy for clear cell RCC from 1970 to 2000 who had distant metastases at nephrectomy (285) or in whom metastases subsequently developed (442). A scoring algorithm to predict cancer specific survival was developed using the regression coefficients from a Cox proportional hazards model.Results: There were 606 deaths from clear cell RCC at a median of 1.0 years (range 0 to 14) following metastatic RCC. Constitutional symptoms at nephrectomy (+2), metastases to the bone (+2) or liver (+4), metastases in multiple simultaneous sites (+2), metastases at nephrectomy (+1) or within 2 years of nephrectomy (+3), complete resection of all metastatic sites (-5), tumor thrombus level I to IV (+3), and the primary pathological features of nuclear grade 4 (+3) and histological tumor necrosis (+2) were significantly associated with death from RCC. All patients started with a score of 0 and points were added or subtracted as indicated in parentheses. Cancer specific survival rates at 1 year were 85.1%, 72.1%, 58.8%, 39.0%, and 25.1%, respectively, for patients with scores of -5 to -1, scores of 0 to 2, scores of 3 to 6, scores of 7 or 8, and scores of 9 or more.Conclusions: This scoring algorithm can be used to predict cancer specific survival for patients with metastatic clear cell RCC.