Constructing a risk predictive model for recurrence following nephron-sparing surgery in the treatment of clear cell renal cell carcinoma

Abstract

Abstract: Objective To detect factors associated with recurrence after nephron-sparing surgery (NSS) in patients with localized clear cell renal cell carcinoma (ccRCC), and to construct a model for predicting the recurrence risk in five years following NSS. Methods Data of the patients who underwent NSS for renal occupied lesions between January 2006 and July 2019 at Peking University Third Hospital were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to assess the factors associated with recurrence of ccRCC after NSS, and a nomogram was established to predict recurrence risk in 5 years following NSS. Results Totally 795 patients who were pathologically diagnosed with ccRCC were included in the study. Recurrence occurred in 17 cases, with the recurrence rate 2.1%. The median time to relapse was 35.7 months. In the univariable analysis, BMI (HR=4.102, P＜ 0.05), the artery blocking time (HR=0.194, P＜ 0.01) and tumor necrosis or sarcomatoid change (HR=5.160, P＜ 0.01) were associated with recurrence-free survival of the ccRCC patients after NSS. The multivariate analysis showed that these three factors were independent factors of recurrence. The accuracy of our nomogram for recurrence risk was verified using internal validation, and the value of c-index was 0.843. Conclusions BMI, artery blocking time and tumor necrosis or sarcomatoid change were independent factors for recurrence following NSS in the ccRCC patients. An accurate model to predict the recurrence risk is constructed, which may help to provide personalized managements for the aforementioned patients after NSS.

Key words: clear cell renal cell carcinoma, nephron-sparing surgery, recurrence, prognosis, nomogram

CLC Number:

R692.9

CHEN Zhi-gang, HONG Peng, YANG Bin, TIAN Xiao-jun, WANG Guo-liang, ZHANG Shu-dong, MA Lu-lin. Constructing a risk predictive model for recurrence following nephron-sparing surgery in the treatment of clear cell renal cell carcinoma[J]. Basic & Clinical Medicine, 2021, 41(3): 409-414.

References

[1] Lane BR, Campbell SC, Gill IS. 10-year oncologic outcomes after laparoscopic and open partial nephrectomy[J]. J Urol, 2013, 190: 44-49.
[2] Kattan MW, Reuter V, Motzer RJ, et al. A postoperative prognostic nomogram for renal cell carcinoma[J]. J Urol, 2001, 166:63-67.
[3] Patard JJ, Kim HL, Lam JS, et al. Use of the University of California Los Angeles integrated staging system to predict survival in renal cell carcinoma: an international multicenter study[J]. J Clin Oncol, 2004, 22:3316-3322.
[4] Frank I, Blute ML, Cheville JC, et al. An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score[J]. J Urol, 2002, 168:2395-2400.
[5] Yaycioglu O, Roberts WW, Chan T, et al. Prognostic assessment of nonmetastatic renal cell carcinoma: a clinically based model[J]. Urology, 2001, 58:141-145.
[6] Cindolo L, de la Taille A, Messina G, et al. A preoperative clinical prognostic model for non-metastatic renal cell carcinoma[J]. BJU Int, 2003, 92:901-905.
[7] Zhang Z, Lin E, Zhuang H, et al. Construction of a novel gene-based model for prognosis prediction of clear cell renal cell carcinoma[J]. Cancer Cell Int, 2020, 20:27. doi: 10.1186/s12935-020-1113-6.
[8] Chow WH, Dong LM, Devesa SS. Epidemiology and risk factors for kidney cancer[J]. Nat Rev Urol, 2010, 7:245-257.
[9] Hakimi AA, Furberg H, Zabor EC, et al. An epidemiologic and genomic investigation into the obesity paradox in renal cell carcinoma[J]. J Natl Cancer Inst, 2013, 105:1862-1870.
[10] Donat SM, Salzhauer EW, Mitra N, et al. Impact of body mass index on survival of patients with surgically treated renal cell carcinoma[J]. J Urol, 2006, 175:46-52.
[11] Steffens S, Ringe KI, Schroeer K, et al. German Renal Cell Tumor Network. Does overweight influence the prognosis of renal cell carcinoma? Results of a multicenter study[J]. Int J Urol, 2013, 20:585-592.
[12] Komura K, Inamoto T, Black PC, et al. Prognostic significance of body mass index in Asian patients with localized renal cell carcinoma[J]. Nutr Cancer, 2011, 63:908-915.
[13] Volpe A, Blute ML, Ficarra V, et al. Renal ischemia and function after partial nephrectomy: a collaborative review of the literature[J]. Eur Urol, 2015, 68:61-74.
[14] Brookman-May S, May M, Shariat SF, et al. Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN Project)[J]. Eur Urol, 2013, 64:472-477.
[15] Zhang L, Wu B, Zha Z, et al. The prognostic value and clinicopathological features of sarcomatoid differentiation in patients with renal cell carcinoma: a systematic review and metaanalysis[J]. Cancer Manag Res, 2018, 10:1687-1703.