Abstract
ObjectivesTo investigate the survival characteristics of postoperative nonmetastatic renal cell carcinoma (RCC) patients, and the predictive value of a prognostic model.Materials and MethodsWe retrospectively evaluated data from 1202 postoperative nonmetastatic RCC patients who were treated between 1999 and 2012 at West China Hospital, Sichuan University (Chengdu, China). In addition, we also evaluated data relating to 53 205 cases acquired from the Surveillance, Epidemiology, and End Results (SEER) program. Survival analysis was performed on the cases, and subgroups, using the Kaplan‐Meier and Cox regression methods. The concordance index of the Stage Size Grade Necrosis (SSIGN), Leibovich, and the UCLA integrated staging system, scores was determined to evaluate the accuracy of these outcome prediction models.ResultsThe 5‐year overall survival rate for RCC cases in West China Hospital was 87.6%; this was higher than that observed for SEER cases. Survival analysis identified several factors that exerted significant influence over prognosis, including the time of surgery, Eastern Cooperative Oncology Group performance status, tumor stage, size, nuclear differentiation, pathological subtypes, along with necrotic and sarcomatoid differentiation. Moreover tumor stage, size, and nuclear grade were all identified as independent predictors for both our cases and those from the SEER program. Patient groups with advanced RCC, and poorly differentiated RCC subgroups, were both determined to have a poor prognosis. The SSIGN model yielded the best predictive value as a prognostic model, followed by the Leibovich, and UCLA integrated staging system; this was the case for our patients, and for sub‐groups with a poor prognosis.ConclusionThe prognosis of RCC was mostly influenced by tumor stage, size, and nuclear differentiation. SSIGN may represent the most suitable prognostic model for the Chinese population.
Highlights
Renal cell carcinoma (RCC) accounts for 2%-3% of all malignant tumors in adults
Multivariate analysis was performed in these two subgroups; we found that tumor N stage, and size, were independent predictors for each subgroup of West China Hospital (WCH) cases, while age, tumor stage, size, nuclear differentiation, and pathological subtypes were independent predictors for the SEER cases (Supplemental Material Table S1)
These previous findings concurred with our present findings, which failed to identify any significant association for gender in either the WCH or SEER cases (2018)
Summary
Renal cell carcinoma (RCC) accounts for 2%-3% of all malignant tumors in adults. Of all patients with RCC, approximately 30% have advanced-stage RCC at the time of diagnosis. As the standard treatment of advanced RCC, sunitinib is known to significantly prolong disease-free survival (DFS), and overall survival (OS), compared with α- interferon.[2] immune checkpoint inhibitors have shown superior treatment effects than standard target drugs in recent trails. The two anti-programmed death 1 (PD-1) monoclonal antibodies, nivolumab and pembrolizumab, both demonstrated better survival rates than sunitinb, when combined with ipilimumab or axitinib separately,[3,4] and better effects for the programmed death ligand 1 (PD-L1) monoclonal antibody, avelumab, when combined with axitinib.[5] as yet, trials have yet to demonstrate the benefit of adjuvant therapy in terms of survival, irrespective of whether we consider sorafenib, sunitinib, pazopanib, or axitinib.[6,7,8] First, it is worth considering the initiation of trails to investigate therapeutic protocols for RCC that utilize adjuvant immune checkpoint inhibitors. It is reasonable to hypothesize that more rational stratification of adjuvant therapies might lead to specific patients receiving greater levels of benefit
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