Editorial Comment to GRade, Age, Nodes, and Tumor (GRANT) compared with Leibovich score to predict survival in localized renal cell carcinoma: A nationwide study

Abstract

It would be of great use to objectively predict the postoperative outcome of progression for patients with localized renal cell carcinoma (RCC) who underwent radical or partial nephrectomy. Leibovich et al. reported a prediction model after surgery for localized RCC in 2003 when radical nephrectomy was a standard therapy for T1 RCC. They proposed scoring algorithm using five parameters, such as pathological T stage, pathological N stage, tumor size, nuclear grade, and histological tumor necrosis. However, this scoring system has not been so popular because it is difficult to collect five parameters precisely, especially presence or absence of tumor necrosis. They also reported the updated model for predicting oncologic outcomes in RCC after surgery in 2018. In 2017, to more easily predict outcome after nephrectomy, GRade, Age, Nodes, and Tumor (GRANT) scoring system was reported. It was based on four easily obtained parameters: Fuhrman grade, age, pathological nodal status and pathological tumor size. In this article, Juul et al. compared GRANT system with Leibovich algorithm to evaluate which is more feasible to predict patient prognosis using the nationwide Danish RCC database. 1 They concluded that both Leibovich and GRANT system were useful in assessing recurrence and survival risk groups in clear and non-clear cell RCC. They also mentioned that Leibovich scoring model outperformed GRANT model when five parameters for Leibovich model are available.In 2022, Rosiello et al. reported the results of head-to-head comparison of all the prognostic models recommended by the European Association of Urology (EAU) guidelines to predict oncologic outcomes in patients with RCC. 2 There are five prognostic models for predicting oncologic outcomes in patients with localized RCC that EAU guidelines 2021 strongly recommend, namely UCLA Integrated Staging System (UISS), 3 Leibovich score 2003, Leibovich score 2018, VENUSS score, 4 and GRANT score. UISS utilizes three parameters (Tumor, Nodes, and Metastasis stage, Fuhrman grade, and Eastern Cooperative Oncology Group performance status) and VENUSS score is based on tumor size, T stage, N stage, presence of venous tumor thrombus, and nuclear grade. They concluded that there is a non-negligible difference in terms of performance accuracy among five models. Leibovich score 2018 is the most accurate prognostic model for patients with clear cell RCC. On the other hand, VENUSS or UISS is the most accurate predicting tool for patients with papillary or chromophobe RCC. These scoring models could make patient's risk stratification easier for planning the postoperative follow-up program after radical or partial nephrectomy for localized RCC.