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

Frank, Igor; Blute, Michael L.; Cheville, John C.; Lohse, Christine M.; Weaver, Amy L.; Zincke, Horst

doi:10.1016/s0022-5347(05)64153-5

Cited by 1,001 publications

(610 citation statements)

References 22 publications

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“…The associations of B7-H1 and B7-H4 tumor expression with death from any cause, death from RCC, and cancer progression were evaluated by using Cox proportional hazards regression models. Associations with death from RCC were further adjusted for the SSIGN (stage, size, grade, and necrosis) score, a prognostic composite score specifically developed for patients with clear cell RCC (34). These associations were summarized by using risk ratios and 95% C.I.s.…”

Section: B7-h4 Immunohistochemical Stainingmentioning

confidence: 99%

B7-H4 expression in renal cell carcinoma and tumor vasculature: Associations with cancer progression and survival

Krambeck¹,

Thompson²,

Dong³

et al. 2006

Proc. Natl. Acad. Sci. U.S.A.

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279

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B7-H4 is a recently described B7 family coregulatory ligand that has been implicated as an inhibitor of T cell-mediated immunity. Although expression of B7-H4 is typically limited to lymphoid cells, aberrant B7-H4 expression has also been reported in several human malignancies. To date, associations of B7-H4 with clinical outcomes for cancer patients are lacking. Therefore, we examined B7-H4 expression in fresh-frozen tumor specimens from 259 renal cell carcinoma (RCC) patients treated with nephrectomy between 2000 and 2003 and performed correlative outcome analyses. We report that 153 (59.1%) RCC tumor specimens exhibited B7-H4 staining and that tumor cell B7-H4 expression was associated with adverse clinical and pathologic features, including constitutional symptoms, tumor necrosis, and advanced tumor size, stage, and grade. Patients with tumors expressing B7-H4 were also three times more likely to die from RCC compared with patients lacking B7-H4 (risk ratio ‫؍‬ 3.05; 95% confidence interval ‫؍‬ 1.51-6.14; P ‫؍‬ 0.002). Additionally, 211 (81.5%) specimens exhibited tumor vasculature endothelial B7-H4 expression, whereas only 6.5% of normal adjacent renal tissue vessels exhibited endothelial B7-H4 staining. Based on these findings, we conclude that B7-H4 has the potential to be a useful prognostic marker for patients with RCC. In addition, B7-H4 represents a target for attacking tumor cells as well as tumor neovasculature to facilitate immunotherapeutic treatment of RCC tumors. Last, we demonstrate that patients with RCC tumors expressing both B7-H4 and B7-H1 are at an even greater risk of death from RCC.B7-H1 ͉ costimulation ͉ tumor biomarker ͉ immunotherapy ͉ kidney neoplasms

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Section: B7-h4 Immunohistochemical Stainingmentioning

confidence: 99%

B7-H4 expression in renal cell carcinoma and tumor vasculature: Associations with cancer progression and survival

Krambeck¹,

Thompson²,

Dong³

et al. 2006

Proc. Natl. Acad. Sci. U.S.A.

Self Cite

279

251

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“…Park et al [15] reported that a cystic change of more than 5% of the tumor is an independent good prognostic factor. However, it is reported that clear cell RCC tumors with cystic necrosis carry a significantly worse prognosis than cRCCs [16]. …”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Partial Nephrectomy for Peripelvic Cystic Renal Cell Carcinoma: A Single-Center Experience

Yang²,

Zhao³

et al. 2016

Urol Int

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Objective: The study aimed to report our experiences of laparoscopic and open partial nephrectomies on patients with peripelvic cystic renal cell carcinoma (cRCC). Methods: From July 2003 and October 2014, 18 patients with suspected peripelvic cRCCs underwent partial nephrectomies via an open or laparoscopic approach at Nanjing Drum Tower Hospital. Patients' perioperative and oncological outcomes were analyzed and compared between the open partial nephrectomy (OPN) and the laparoscopic partial nephrectomy (LPN) groups. Results: Seven patients underwent OPNs, and 11 patients underwent LPNs for their peripelvic lesions. All procedures were performed successfully; no conversion to open surgery was encountered in the LPN group. There was no significant difference between the groups in mean operation time, blood loss, warm ischemia time or complication rates. The mean hospital stay in the LPN group was significantly shorter than in the OPN group (p = 0.004). The mean follow-up of the OPN and LPN group was 95.0 and 65.1 months, respectively. No local recurrence or metastasis has been noted during the follow-up period. Conclusions: Peripelvic cRCC represents an uncommon variant of RCCs; few cases have been reported addressing peripelvic cRCC treatment. Although technically challenging, LPN is an effective minimally invasive modality for treating peripelvic cRCC in experienced hands.

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“…FNG is frequently used for RCC prognosis and is a component of many prognostic predictor scores, such as the UCLA Integrated Staging System (UISS) [15] and the Mayo Clinic tumor stage, size, grade and necrosis (SSIGN) score [16,17]. Therefore, it was surprising that MHCI expression was found to be independent of FNG.…”

Section: Discussionmentioning

confidence: 99%

High Expression of Major Histocompatibility Complex Class I in Clear Cell Renal Cell Carcinoma Is Associated with Improved Prognosis

Holzman

Calle²,

Osunkoya³

et al. 2015

Urol Int

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Introduction: In this study we analyzed major histocompatibility complex class I (MHCI) expression as a potential prognostic immune marker for patients with clear cell renal cell carcinoma (ccRCC). Patients and Methods: 34 patients with localized ccRCC (pT1-pT3) who had undergone nephrectomy and had at least 4 years of clinical follow-up data were included in the study. Immunohistochemical staining for MHCI was performed on tumor sections. An automated image analysis algorithm was applied to representative tumor areas to quantitate the proportion of stained pixels (positivity score = positive pixels/total pixels) on scanned digital slides. Results: At the end of the study, the patients who were alive had increased MHCI expression (mean positivity score 0.80) compared to those who died of the disease (mean positivity score 0.53; p < 0.0001, t test). Patients who were alive with recurrence had increased MHCI expression (positivity score 0.81) compared to those who succumbed to their disease recurrence (positivity score 0.53; p < 0.0001, t test). Survival was higher among patients with high MHCI expression compared to patients with low MHCI expression (p < 0.0001, Mantel-Cox). Conclusions: With an automated high-throughput image analysis technique, this study shows that higher tumor cell MHCI expression promotes increased survival and reduced incidence of recurrence compared to patients with lower tumor cell MHCI expression.

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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

Abstract: In patients with clear cell renal cell carcinoma 1997 TNM stage, tumor size, nuclear grade and histological tumor necrosis were significantly associated with cancer specific survival. We present a scoring system based on these features that can be used to predict outcome.

Cited by 1,001 publications

References 22 publications

B7-H4 expression in renal cell carcinoma and tumor vasculature: Associations with cancer progression and survival

B7-H4 expression in renal cell carcinoma and tumor vasculature: Associations with cancer progression and survival

Laparoscopic Partial Nephrectomy for Peripelvic Cystic Renal Cell Carcinoma: A Single-Center Experience

High Expression of Major Histocompatibility Complex Class I in Clear Cell Renal Cell Carcinoma Is Associated with Improved Prognosis

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