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.
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).
This was a retrospective analysis of a multi-institutional nationwide data set for patients with pT3N0M0 ccRCC who underwent radical nephrectomy and thrombectomy.
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.
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).
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.
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.
European urology oncology. 2023 Jul 17 [Epub ahead of print]
Zhenjie Wu, Hui Chen, Qi Chen, Silun Ge, Nengwang Yu, Riccardo Campi, Juan Gómez Rivas, Riccardo Autorino, Morgan Rouprêt, Sarah P Psutka, Reza Mehrazin, Francesco Porpiglia, Karim Bensalah, Peter C Black, Maria C Mir, Andrea Minervini, Hooman Djaladat, Vitaly Margulis, Riccardo Bertolo, Anna Caliò, Umberto Carbonara, Daniele Amparore, Leonardo D Borregales, Chiara Ciccarese, Pietro Diana, Selcuk Erdem, Laura Marandino, Michele Marchioni, Constantijn H J Muselaers, Carlotta Palumbo, Nicola Pavan, Angela Pecoraro, Eduard Roussel, Hannah Warren, Savio Domenico Pandolfo, Rui Chen, Wenquan Zhou, Wei Zhai, Miaoxia He, Yaoming Li, Bo Han, Jie Wan, Xing Zeng, Junan Yan, Yao Fu, Changwei Ji, Xiang Fan, Guangyuan Zhang, Cheng Zhao, Taile Jing, Anbang Wang, Chenchen Feng, Hongwei Zhao, Di Sun, Liang Wang, Sheng Tai, Cheng Zhang, Shaohao Chen, Yixun Liu, Zhipeng Xu, Haifeng Wang, Jinli Gao, Fubo Wang, Jiwen Cheng, He Miao, Qiu Rao, Jianning Wang, Ning Xu, Gongxian Wang, Chaozhao Liang, Zhiyu Liu, Dan Xia, Jun Jiang, Xiongbing Zu, Ming Chen, Hongqian Guo, Weijun Qin, Zhe Wang, Wei Xue, Benkang Shi, Xiaojun Zhou, Shaogang Wang, Junhua Zheng, Jingping Ge, Xiang Feng, Minming Li, Cheng Chen, Le Qu, Linhui Wang, REMEMBER Consortium and the European Association of Urology Young Academic Urologists Renal Cancer Working Group
Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China; European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands. Electronic address: ., Department of Pathology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China., Department of Health Statistics, Naval Medical University, Shanghai, China., Department of Urology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China., Department of Urology, Qilu Hospital, Shandong University, Jinan, China., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Department of Urology, Hospital Clinico San Carlos, Madrid, Spain., Department of Urology, Rush University Medical Center, Chicago, IL, USA., Department of Urology, GRC No. 5, Predictive ONCO-URO, Hospital Pitié-Salpêtrière, AP-HP, Sorbonne University, Paris, France., Department of Urology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy., Department of Urology, University of Rennes, Rennes, France., Department of Urologic Sciences, The University of British Columbia, Vancouver, British Columbia, Canada., Department of Urology; Hospital Universitario La Ribera; Valencia, Spain., Departments of Urology and Experimental and Clinical Medicine, University of Florence, Florence, Italy., Institute of Urology, University of Southern California, Los Angeles, CA, USA., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Urology Unit, San Carlo di Nancy Hospital, Rome, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Diagnostic and Public Health, University of Verona, Verona, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urologic Oncology, Department of Urology, Istanbul University Faculty of Medicine, Istanbul, Turkey., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Medical, Oral and Biotechnological Sciences, Urology Unit, University G. d'Annunzio, Chieti, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Urology Clinic, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Pederzoli Hospital, Peschiera del Garda, Italy., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, University Hospitals Leuven, Leuven, Belgium., European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Surgery and Interventional Science, University College London, London, UK., Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China., Department of Urology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China., Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China., Department of Pathology, Changhai Hospital, Naval Medical University, Shanghai, China., Department of Urology, Daping Hospital, Army Medical University, Chongqing, China., Department of Pathology, Qilu Hospital, Shandong University, Jinan, China., Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China., Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China., Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China., Department of Pathology, Drum Tower Hospital, Clinical School of Nanjing University Medical College, Nanjing, China., Department of Urology, Drum Tower Hospital, Clinical School of Nanjing University Medical College, Nanjing, China., Department of Pathology, Zhongda Hospital, Southeast University, Nanjing, China., Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China., Department of Urology, Xiangya Hospital, Central South University, Changsha, China., Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China., Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China., Department of Urology, Huashan Hospital, Fudan University, Shanghai, China., Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, China., Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, China., Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China., Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China., Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China., Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China., Department of Urology, Anhui Provincial Hospital/The First Hospital of the University of Science and Technology of China, Hefei, China., Department of Urology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China., Department of Urology, Shanghai East Hospital, Tongji University, Shanghai, China., Department of Pathology, Shanghai East Hospital, Tongji University, Shanghai, China., Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China., Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China., Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China., Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, China., Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China. Electronic address: ., Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China. Electronic address: ., Department of Medical Oncology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China. Electronic address: ., Department of Urology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China. Electronic address: ., Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China. Electronic address: .