Prognostic Significance of Grade Discrepancy Between Primary Tumor and Venous Thrombus in Nonmetastatic Clear-cell Renal Cell Carcinoma: Analysis of the REMEMBER Registry and Implications for Adjuvant Therapy
- Authors: Wu Z.; Chen H.; Chen Q.; Ge S.; Yu N.; Campi R.; Gomez Rivas J.; Autorino R.; Roupret M.; Psutka S.P.; Mehrazin R.; Porpiglia F.; Bensalah K.; Black P.C.; Mir M.C.; Minervini A.; Djaladat H.; Margulis V.; Bertolo R.; Calio A.; Carbonara U.; Amparore D.; Borregales L.D.; Ciccarese C.; Diana P.; Erdem S.; Marandino L.; Marchioni M.; Muselaers C.H.J.; Palumbo C.; Pavan N.; Pecoraro A.; Roussel E.; Warren H.; Pandolfo S.D.; Chen R.; Zhou W.; Zhai W.; He M.; Li Y.; Han B.; Wan J.; Zeng X.; Yan J.; Fu Y.; Ji C.; Fan X.; Zhang G.; Zhao C.; Jing T.; Wang A.; Feng C.; Zhao H.; Sun D.; Wang L.; Tai S.; Zhang C.; Chen S.; Liu Y.; Xu Z.; Wang H.; Gao J.; Wang F.; Cheng J.; Miao H.; Rao Q.; Wang J.; Xu N.; Wang G.; Liang C.; Liu Z.; Xia D.; Jiang J.; Zu X.; Chen M.; Guo H.; Qin W.; Wang Z.; Xue W.; Shi B.; Zhou X.; Wang S.; Zheng J.; Ge J.; Feng X.; Li M.; Chen C.; Qu L.; Wang L.
- Publication year: 2024
- Type: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/662459
Abstract
BACKGROUND: Further stratification of the risk of recurrence of clear-cell renal cell carcinoma (ccRCC) with venous tumor thrombus (VTT) will facilitate selection of candidates for adjuvant therapy. OBJECTIVE: To assess the impact of tumor grade discrepancy (GD) between the primary tumor (PT) and VTT in nonmetastatic ccRCC on disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS). DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective analysis of a multi-institutional nationwide data set for patients with pT3N0M0 ccRCC who underwent radical nephrectomy and thrombectomy. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS: Pathology slides were centrally reviewed. GD, a bidirectional variable (upgrading or downgrading), was numerically defined as the VTT grade minus the PT grade. Multivariable models were built to predict DFS, OS, and CSS. RESULTS AND LIMITATIONS: We analyzed data for 604 patients with median follow-up of 42 mo (excluding events). Tumor GD between VTT and PT was observed for 47% (285/604) of the patients and was an independent risk factor with incremental value in predicting the outcomes of interest (all p < 0.05). Incorporation of tumor GD significantly improved the performance of the ECOG-ACRIN 2805 (ASSURE) model. A GD-based model (PT grade, GD, pT stage, PT sarcomatoid features, fat invasion, and VTT consistency) had a c index of 0.72 for DFS. The hazard ratios were 8.0 for GD = +2 (p < 0.001), 1.9 for GD = +1 (p < 0.001), 0.57 for GD = -1 (p = 0.001), and 0.22 for GD = -2 (p = 0.003) versus GD = 0 as the reference. According to model-converted risk scores, DFS, OS, and CSS significantly differed between subgroups with low, intermediate, and high risk (all p < 0.001). CONCLUSIONS: Routine reporting of VTT upgrading or downgrading in relation to the PT and use of our GD-based nomograms can facilitate more informed treatment decisions by tailoring strategies to an individual patient's risk of progression. PATIENT SUMMARY: We developed a tool to improve patient counseling and guide decision-making on other therapies in addition to surgery for patients with the clear-cell type of kidney cancer and tumor invasion of a vein.