Abstract
BackgroundTo compare the predictive value of the current AJCC stage grouping for renal cell carcinoma (RCC) to our modifications.Patients and methodsA total of 2120 patients with RCC from Fudan University Shanghai Cancer Center (FUSCC) database and 74 506 counterparts from SEER database were included. Cox regression was used to calculate the relative impacts between prognostic groups. The predictive accuracy of overall survival (OS) was assessed using the concordance index (C‐index), which was compared by likelihood ratio test.ResultsIn FUSCC cohort, the 5‐year‐OS rate for T3N0M0 patients was higher than T1‐3N1M0 (72.7% vs 38.1%). The 5‐year‐OS rate for T4N0M0 was 36.2%, which was close to T1‐3N1M0 but not to T4N1M0 (0%) and TanyNanyM1 (12.6%). The elements of AJCC groups were regrouped according to the ranks of hazard ratios. The modified stages II (T3N0M0), III (T1‐3N1M0, T4N0M0), and IV (T4N1M0, TanyNanyM1) exhibited greater survival stratification than AJCC groups. The modifications were validated in SEER cohort and yielded similar survival outcomes. The predictive accuracy of OS in modified prognostic groups was significantly higher than AJCC groups in stages II‐IV subgroups in both FUSCC (C‐index: 0.801 vs 0.779, P < 0.001) and SEER cohort (C‐index: 0.770 vs 0.764, P < 0.001).ConclusionsThe modified AJCC prognostic groups for RCC provided significantly improved survival prediction compared with the 8th AJCC edition. A precise risk stratification of modified stages II‐IV disease provides an important basis for risk‐equivalent treatment recommendation.
Highlights
T1‐3N1M0 and T4N0M0 were classified as stage III
T4N1M0 and TanyNanyM1 were classified as stage IV (Figure 2B)
We found that T1‐3N1M0 and T3N0M0 were arranged in the same stage III (HR = 3.23) in the 8th American Joint Committee on Cancer (AJCC) stage grouping was unreasonable
Summary
The American Joint Committee on Cancer (AJCC) tumor‐ node‐metastasis stage grouping (TNM) is the most commonly. To compare the predictive value of the current AJCC stage grouping for renal cell carcinoma (RCC) to our modifications. The predictive accuracy of OS in modified prognostic groups was significantly higher than AJCC groups in stages II‐IV subgroups in both FUSCC (C‐index: 0.801 vs 0.779, P < 0.001) and SEER cohort (C‐index: 0.770 vs 0.764, P < 0.001). Conclusions: The modified AJCC prognostic groups for RCC provided significantly improved survival prediction compared with the 8th AJCC edition. A precise risk stratification of modified stages II‐IV disease provides an important basis for risk‐ equivalent treatment recommendation
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