Abstract
The purpose of the present study was to validate the new GRade, Age, Nodes and Tumor (GRANT) score for renal cell carcinoma (RCC) prognostication within a large population of patients. Within the Surveillance, Epidemiology, and End Results database, we identified patients with either clear-cell or papillary RCC, who underwent nephrectomy between 2001 and 2015. Harrell’s C-Index, calibration plot and decision curve analysis were used to validate the GRANT model using a five-risk group stratification (0 vs. 1 vs. 2 vs. 3 vs. 4 risk factors). The primary endpoint was overall survival (OS) at 60 months. The analyses were repeated according to the histologic subgroup. The overall population included 73217 cases; 60900 with clear-cell RCC and 12317 with papillary histology, respectively. According to a five-risk group stratification, 23985 patients (32.8%) had no risk factor (0), 35019 (47.8%) had only one risk factor (1), 13275 (18.1%) had risk score 2, 854 (1.2%) had 3 risk factors and 84 (0.1%) of cases had a GRANT score of 4, respectively. At 60 months, OS rates as determined by the GRANT score were respectively 94% (score 0) vs. 86% (score 1) vs. 76% (score 2) vs. 46% (score 3) vs. 16% (score 4). In both histologic subtypes, the GRANT score yielded good calibration and high net benefit. OS C-Index values were 0.677 and 0.650 for clear-cell and papillary RCC at 60 months after surgery, respectively. In conclusion, the GRANT score was validated with a five-risk group stratification in a huge population from the SEER database, offering a further demonstration of its reliability for prognostication in RCC.
Highlights
The purpose of the present study was to validate the new GRade, Age, Nodes and Tumor (GRANT) score for renal cell carcinoma (RCC) prognostication within a large population of patients
Within the Surveillance, Epidemiology, and End Results database, we identified patients with either clear-cell or papillary RCC, who underwent nephrectomy between 2001 and 2015
The GRANT score appeared to slightly underpredict the risk of mortality at 60 months compared to the actual 60-month mortality rates that we have registered within the SEER population
Summary
The purpose of the present study was to validate the new GRade, Age, Nodes and Tumor (GRANT) score for renal cell carcinoma (RCC) prognostication within a large population of patients. The best-known nomograms for the risk assessment after surgical treatment of localized RCC are the University of California Los Angeles Integrated Staging System (UISS), predicting overall survival (OS) in patients with RCC regardless of the histologic subtype, and the Mayo Clinic Stage, Size, Grade and Necrosis (SSIGN) model, predicting cancer-specific survival in patients with clear-cell RCC3–5. The Karakiewicz nomogram was shown to be superior to other validated models (the Kattan, the Sorbellini and the Leibovich nomograms) predicting survival outcomes in localized RCC11. All these nomograms are currently little used due to their relative complexity of calculation and to the scarce availability of some required parameters. An impediment to the widespread clinical adoption and to the external validation of the SSIGN and the Leibovich scores was represented by their reliance on tumor necrosis, a pathological variable without standardized definition, not quickly available at most centers (especially in the frequent context of the private practice) and with no consensus on the correct reporting method[12]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
