The VENUSS prognostic model to predict disease recurrence following surgery for non-metastatic papillary renal cell carcinoma: development and evaluation using the ASSURE prospective clinical trial cohort.
Riddick, Antony CP
Armitage, James N
'Aho, Tevita F
Pantuck, Allan J
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Klatte, T., Gallagher, K. M., Afferi, L., Volpe, A., Kroeger, N., Ribback, S., McNeill, A., et al. (2019). The VENUSS prognostic model to predict disease recurrence following surgery for non-metastatic papillary renal cell carcinoma: development and evaluation using the ASSURE prospective clinical trial cohort.. BMC medicine, 17 (1), 182. https://doi.org/10.1186/s12916-019-1419-1
Background: The current World Health Organisation classification recognises twelve major subtypes of renal cell carcinoma (RCC). Although these subtypes differ on molecular and clinical levels, they are generally managed as the same disease, simply because they occur in the same organ. Specifically, there is a paucity of tools to risk-stratify patients with papillary RCC (PRCC). The purpose of this study was to develop and evaluate a tool to risk-stratify patients with clinically non-metastatic PRCC following curative surgery. Methods: We studied clinicopathological variables and outcomes of 556 patients, who underwent full resection of sporadic, unilateral, non-metastatic (T1-4, N0-1, M0) PRCC at five institutions. Based on multivariable Fine-Gray competing risks regression models, we developed a prognostic scoring system to predict disease recurrence. This was further evaluated in the 150 PRCC patients recruited to the ASSURE trial. We compared the discrimination, calibration and decision-curve clinical net benefit against the Tumour, Node, Metastasis (TNM) stage group, University of California Integrated Staging System (UISS) and the 2018 Leibovich prognostic groups. Results: We developed the VENUSS score from significant variables on multivariable analysis, which were, presence of VEnous tumour thrombus, NUclear grade, Size, T and N Stage. We created three risk groups based on the VENUSS score, with a 5-yr cumulative incidence of recurrence equalling 2.9% in low risk, 15.4% in intermediate risk and 54.5% in high risk patients. 91.7% of low risk patients had oligometastatic recurrent disease, compared to 16.7% of intermediate risk and 40.0% of high risk patients. Discrimination, calibration and clinical net benefit from VENUSS appeared to be superior to UISS, TNM and Leibovich prognostic groups. Conclusions: We developed and tested a prognostic model for patients with clinically non-metastatic PRCC, which is based on routine pathological variables. This model may be superior to standard models and could be used for tailoring postoperative surveillance and defining inclusion for prospective adjuvant clinical trials.
Humans, Carcinoma, Renal Cell, Kidney Neoplasms, Neoplasm Recurrence, Local, Neoplasm Staging, Prognosis, Treatment Outcome, Incidence, Models, Statistical, Risk Factors, Cohort Studies, Prospective Studies, Predictive Value of Tests, Research Design, Adult, Aged, Middle Aged, Female, Male, Clinical Trials as Topic
External DOI: https://doi.org/10.1186/s12916-019-1419-1
This record's URL: https://www.repository.cam.ac.uk/handle/1810/297671
Attribution 4.0 International
Licence URL: https://creativecommons.org/licenses/by/4.0/