Risk Group Assessment and Clinical Outcome Algorithm to Predict the Natural History of Patients With Surgically Resected Renal Cell Carcinoma

TLDR

At diagnosis, 43 % of patients had metastatic disease while 57 % had non‑metastatic disease. The study aims to develop a comprehensive algorithm to predict postoperative RCC outcomes and guide therapy, enabling better counseling and identification of high‑risk non‑metastatic patients needing adjuvant treatment. Using the UCLA Integrated Staging System, tumor‑node‑metastasis staging, grade, and performance status, the authors constructed decision boxes that classify patients into low, intermediate, and high risk groups, forming a clinically useful algorithm. NM‑LR patients achieved 91 % 5‑year disease‑specific survival, whereas NM‑HR patients progressed in 50 % of cases, had poorer survival and shorter time from recurrence to death; M‑HR patients performed poorly despite immunotherapy, while M‑LR and M‑IR patients had long‑term progression‑free survival after immunotherapy.

Abstract

To create a comprehensive algorithm that can predict postoperative renal cell carcinoma (RCC) patient outcomes and response to therapy.A prospective cohort study was performed with outcome assessment on the basis of chart review of 814 patients who underwent nephrectomy between 1989 and 2000. At diagnosis, M1 or N1/N2M0 metastatic disease (M) was present in 346 patients (43%), whereas 468 patients had no metastatic disease (NM) (N0M0). On the basis of UCLA Integrated Staging System category and the presence of metastases, patients were divided into low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups. Decision boxes integrating tumor-node-metastasis staging, tumor grade, and performance status were compiled for determining a patient's risk group.NM-LR patients had 91% disease-specific survival at 5 years, lower recurrence rate, and better disease-free survival compared with NM-IR and HR patients. Disease progressed in 50% of NM-HR patients. Disease-specific survival of NM-HR patients who received immunotherapy (IMT) for recurrent disease was similar to that of M-LR patients treated with cytoreductive nephrectomy and adjuvant IMT. Time from recurrence to death for NM-HR patients was inferior to that for M-LR patients. After IMT, approximately 25% of M-LR and 12% of M-IR patients had long-term progression-free survival. M-HR patients did poorly despite IMT.Stratifying RCC patients into high-, intermediate-, and low-risk subgroups provides a clinically useful system for predicting outcome and provides a unique tool for risk assignment and outcome analysis. Subclassifying RCC into well-defined risk groups should allow better patient counseling and identification of both NM-HR subgroups that need adjuvant treatment and nonresponders who need alternative therapies.