title: Significance of conventional and new prognostic factors for locally confined renal cell carcinoma.
abstract: BACKGROUND
  The prognosis of patients with locally confined renal cell carcinoma is variable. To improve the prognostic knowledge and select patients at high risk, additional prognostic parameters are needed.
  
  
  METHODS
  The significance with respect to survival and tumor recurrence of "classic" and "new" prognostic parameters has been examined by following 41 patients with locally confined renal cell carcinoma after nephrectomy (mean follow-up, 5.2 years). The significance of histologic grade, tumor stage, Ki-67 index, proliferating cell nuclear antigen index, 3H-thymidine labeling index, tumor ploidy status, and tumor growth after xenotransplantation into nude mice (GAX range) was tested using the Kaplan-Meier plots by the log rank test or Tarone's test and also by the Cox multiple hazard regression analysis.
  
  
  RESULTS
  Tumor stage (P < 0.0025), histologic grade (P < 0.005), Ki-67 index (P < 0.006), and GAX range (P < 0.00004) were found to be significant prognostic parameters for survival and tumor recurrence using single-factor analysis. Applying the multivariate analysis, the combination of the "new" factors, GAX range and Ki-67 index, resulted in even a higher prognostic relevance than the combination of the "classic" prognostic factors, tumor stage and histologic grade. The calculated prognostic index based on the results of the Cox analysis, which, except for stage and grade, included the Ki-67 index, was shown to be highly correlated with survival (P = 0.00002) and tumor recurrence (P = 0.0004). Its prognostic validity was studied with the receiver operating characteristics procedure and was found to be considerably superior to that of the two conventional prognosticators.
  
  
  CONCLUSIONS
  The additional determination of the Ki-67 labeling index increases the prognostic assessment of patients with locally confined renal cell carcinoma.
authors.affiliation: Department of Urology, University of Würzburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Hofmockel
authors.forename: P
authors.initials: P
authors.lastname: Tsatalpas
authors.forename: H
authors.initials: H
authors.lastname: Müller
authors.forename: J
authors.initials: J
authors.lastname: Dämmrich
authors.forename: M
authors.initials: M
authors.lastname: Poot
authors.forename: B
authors.initials: B
authors.lastname: Maurer-Schultze
authors.forename: H K
authors.initials: HK
authors.lastname: Müller-Hermelink
authors.forename: H G
authors.initials: HG
authors.lastname: Frohmüller
authors.forename: I D
authors.initials: ID
authors.lastname: Bassukas
mesh_terms: D000818:Animals; D014408:Biomarkers, Tumor / Q000032:analysis; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000473:pathology; D002455:Cell Division; D004273:DNA, Neoplasm / Q000032:analysis; D018572:Disease-Free Survival; D005260:Female; D019394:Ki-67 Antigen; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008819:Mice, Nude; D015999:Multivariate Analysis; D009363:Neoplasm Proteins / Q000378:metabolism; D009368:Neoplasm Transplantation; D009687:Nuclear Proteins / Q000378:metabolism; D011379:Prognosis; D018809:Proliferating Cell Nuclear Antigen / Q000378:metabolism; D016016:Proportional Hazards Models; D016019:Survival Analysis; D014183:Transplantation, Heterologous
chemical_list: D014408:Biomarkers, Tumor; D004273:DNA, Neoplasm; D019394:Ki-67 Antigen; D009363:Neoplasm Proteins; D009687:Nuclear Proteins; D018809:Proliferating Cell Nuclear Antigen