Predictive Ability for Disease-Free Survival of the GRade, Age, Nodes, and Tumor (GRANT) Score in Patients with Resected Renal Cell Carcinoma

Abstract

Background: Recently, the GRANT (GRade, Age, Nodes, and Tumor) score was validated through an adjuvant trial population. Methods: This retrospective study evaluated the performance of the GRANT score as a prognostic model for disease-free survival (DFS), compared to the University of California Los Angeles Integrated Staging System (UISS) score, in a “real-life” population of early renal cell carcinoma patients. A uni-/multivariate analysis of DFS was also performed, to weigh the roles of baseline clinical factors. Results: From February 1998 to January 2018, 134 consecutive patients were enrolled, of which 85 patients (63.4%) had a favorable GRANT score, 49 (36.6%) an unfavorable GRANT score, and 21 (15.7%), 84 (62.6%), and 29 (21.6%) patients had a low, intermediate, or high risk of recurrence according to the UISS score, respectively. The median follow-up was 96 months. The median DFS of the overall study population was 53.7 months (95% CI: 38.4-87.8). Only bilateral renal cell carcinoma (p = 0.0041), Fuhrman grade 3/4 (p = 0.0008), pT3b- 4 (p = 0.0324), and pN1-2 (p = 0.0303) pathological status were confirmed as independent predictors of a shorter DFS by the multivariate analysis. The median DFS of patients with favorable and unfavorable GRANT scores were 84.9 (95% CI: 49.8-129) and 38.4 months (95% CI: 24.4-87.8), respectively, with a statistically significant difference (p = 0.0147). The median DFS of patients with low, intermediate, and high risk of recurrence according to the UISS score were 92.3 (95% CI: 18.1-153.9), 51.7 (95% CI: 36.2-87.8), and 49.8 months (95% CI: 31.3-129), respectively, without statistically significant differences (p = 0.4728). DFS c-statistic values were 0.59 (95% CI: 0.51-0.67) and 0.51 (95% CI: 0.42-0.60) for the GRANT and the UISS scores, respectively. Conclusion: The GRANT score might be a useful tool that is user-friendly and easy to perform in clinical practice.

A comprehensive correlation of clinicopathologic prognostic factors in malignant adult renal tumors: a single institutional study

“…We found increasing age, size of the tumor, histologic grade, stage, and presence of necrosis to be associated with significantly decreased survival among our cases on univariate cox regression. Gudbjartsson et al, Lamb et al and Cortellini et al also found a similar trend in their case series with respect to age, size, grade, and stage of the tumor as depicted in Table 5 ( 1 , 14 , 15 ). There was no statistically significant difference among the various histologic subtypes.…”

Critical Appraisal of Leibovich 2018 and GRANT Models for Prediction of Cancer-Specific Survival in Non-Metastatic Chromophobe Renal Cell Carcinoma

“…Several prognostic models incorporating clinical and pathological RCC variables have been validated to predict recurrence and mortality after nephrectomy in chRCC [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Of these, two models are recommended by European guidelines to predict cancer control outcomes after nephrectomy in non-metastatic chRCC [ 15 ]: Leibovich 2018 [ 2 , 16 ] and GRade, Age, Nodes and Tumor (GRANT) [ 3 , 16 , 17 , 18 , 19 , 20 ]. However, their ability to predict cancer-specific survival (CSS) has only been validated in a mono-institutional European cohort of 127 chRCC patients [ 16 ].…”

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

“…10 The score is easy to use and has been validated. 11,12 The GRANT score was based on patient age, and pathologic features; Fuhrman grade, nodal status (pN) and tumor size (pT). GRANT has demonstrated excellent discrimination for predicting recurrence in both ccRCC and non-ccRCC patients and may therefore be an acceptable and simpler alternative to the Leibovich score.…”

“…A new risk stratification tool for RCC was recently developed: the GRANT score 10 . The score is easy to use and has been validated 11,12 . The GRANT score was based on patient age, and pathologic features; Fuhrman grade, nodal status (pN) and tumor size (pT).…”