Zisman et al predicted outcome for patients with renal cell carcinoma who underwent surgical resection. This can help identify patients who may benefit from more aggressive or investigational therapies. The authors are from the UCLA.
Exclusions: Patients with bilateral renal involvement.
Parameters:
(1) N and M stage
(2) T stage (based on 1977 UICC classification)
(3) Fuhrman grade
(4) ECOG performance score
NM Group (N0M0)
|
T Stage |
Grade |
ECOG |
Risk Group |
|
T1 |
1 or 2 |
0 |
low |
|
T1 |
1 or 2 |
>= 1 |
intermediate |
|
T1 |
3 or 4 |
0 |
intermediate |
|
T1 |
3 or 4` |
>= 1 |
intermediate |
|
T2 |
any |
any |
intermediate |
|
T3 |
1 |
0 |
intermediate |
|
T3 |
1 |
>= 1 |
intermediate |
|
T3 |
2 or 3 or 4 |
0 |
intermediate |
|
T3 |
2 or 3 or 4 |
>= 1 |
high |
|
T4 |
any |
any |
high |
M Group (N>=1 or M1)
|
NM Stage |
Grade |
ECOG |
Risk Group |
|
N1M0 |
any |
any |
low |
|
N2 or M1 |
1 |
0 |
low |
|
N2 or M1 |
1 |
>= 1 |
intermediate |
|
N2 or M1 |
2 |
0 |
low |
|
N2 or M1 |
2 |
>= 1 |
intermediate |
|
N2 or M1 |
3 |
0 |
intermediate |
|
N2 or M1 |
3 |
>= 1 |
intermediate |
|
N2 or M1 |
4 |
0 |
intermediate |
|
N2 or M1 |
4 |
>= 1 |
high |
|
|
mean 5 year overall survival |
mean 5 year disease specific survival |
mean 5 year freedom from any failure after nephrectomy |
|
N0M0 low |
83.8% |
91.1% |
91.4% |
|
N0M0 intermediate |
71.9% |
80.4% |
64% |
|
N0M0 high |
44% |
54.7% |
37.3% |
|
N+M+ low |
30.3% |
32% |
25% |
|
N+M+ intermediate |
19.3% |
19.5% |
12% |
|
N+m+ high |
0% |
0% |
0% |
from Tables 2 and 3, page 4562
where:
• Freedom from any failure includes failure from local and from systemic failure.
NOTE: In Table I, page 948 of Cady (1988) the high risk group definition uses AND rather than OR for the 2 subgroups under older patients. However, in context the OR seems more appropriate.
Interpretation:
• The original authors (Cady and Rossi, 1988) found a mortality rate ratio of 26:1 between the high and low risk groups.
• Davis et al (1995) found little difference between low and high risk groups when applied to patients with follicular carcinoma. However, it is unclear if they limited metastatic sites to other than lymph nodes in the neck and mediastinum.
Specialty: Hematology Oncology, Surgery, general, Nephrology
ICD-10: ,
