Frank et al developed a predictive model for patients with clear cell renal cell carcinoma based on the tumor stage, size, grade and necrosis. This SSIGN score can be used to predict long-term survival. The authors are from the Mayo Clinic.
Patient selection: clear cell renal cell carcinoma treated with nephrectomy
Parameters:
(1) pathologic T stage using the 1997 TNM staging criteria
(2) pathologic N stage
(3) pathologic M stage
(4) tumor size in centimeters
(5) nuclear grade (based on the highest grade filling at least 1 high powered field)
(6) necrosis
Histologic Features |
Nuclear Grade |
---|---|
small round nuclei with inconspicuous nucleoli visible only at 400x magnification (high dry power) |
1 |
round to slightly irregular nuclei with mildly enlarged nucleoli visible at 200x magnification |
2 |
round to irregular nuclei with prominent nucleoli visible at 100x magnification |
3 |
enlarged, pleomorphic or giant cells present |
4 |
Parameters |
Findings |
Points |
---|---|---|
pathologic T stage |
pT1 |
0 |
|
pT2 |
1 |
|
pT3a |
2 |
|
pT3b |
2 |
|
pT3c |
2 |
|
pT4 |
0 |
pathologic N stage |
pNx |
0 |
|
pN0 |
0 |
|
pN1 |
2 |
|
pN2 |
2 |
pathologic M stage |
pM0 |
0 |
|
pM1 |
4 |
tumor size |
< 5 cm |
0 |
|
>= 5 cm |
2 |
nuclear grade |
1 |
0 |
|
2 |
0 |
|
3 |
1 |
|
4 |
3 |
tumor necrosis |
absent |
0 |
|
present |
2 |
from Table 5, page 2398
where:
• I wondered why pT4 was associated with 0 points. My guess is that other factors like N or M stage, tumor size and necrosis may compensate for this score.
SSIGN score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 15
• The higher the score the worse the prognosis.
SSIGN Score |
10 Year Survival Rate |
---|---|
0 or 1 |
97% |
2 |
85% |
3 |
78% |
4 |
66% |
5 |
50% |
6 |
39% |
7 |
28% |
8 |
13% |
9 |
15% |
>= 10 |
5% |
from Table 6, page 2398
Purpose: To evaluate a patient with a clear cell renal cell carcinoma using the SSIGN predictive model of Frank et al.
Specialty: Hematology Oncology, Surgery, general, Nephrology
Objective: severity, prognosis, stage, response to therapy
ICD-10: C64,