Multi-institutional validation of a symptom based classification for renal cell carcinoma.
OBJECTIVE
We validate the prognostic value of a symptom based classification (S classification) in a multi-institutional study.


METHODS
A total of 2,242 patients from 5 European centers were included in this study. Based on symptoms at diagnosis, patients were stratified into 3 groups of S1-asymptomatic tumors, S2-tumors with local symptoms and S3-tumors with systemic symptoms. Variables such as age, gender, tumor size, TNM stage, Fuhrman grade, Eastern Cooperative Oncology Group (ECOG) performance status, perinephric fat, renal vein and adrenal invasion were also considered for prognostic value. The end point of the study was cancer specific survival. Survival assessment was made with univariate and multivariate analyses using the Kaplan-Meier method and Cox regression analysis.


RESULTS
Of the patients 1,018 (45.4%) were classified as S1, 865 (38.6%) S2 and 339 (16.0%) S3. The S classification correlated to tumor stage, grade and ECOG (p <0.001). On univariate analysis ECOG performance status, S classification, tumor size, TNM stage, Fuhrman grade, and adrenal, perinephric fat or vein invasion were significant prognostic factors (p <0.001). The S classification provided a significant prognostic stratification in the aggregate as well at each of the 5 centers. On multivariate analysis the S classification, TNM stage, Fuhrman grade, and perinephric fat and renal vein invasion remained independent prognostic factors (p <0.001).


CONCLUSIONS
This study confirms that it is possible to graduate symptoms for a prognostic purpose. The proposed symptom score should be evaluated for its integration in prognostic algorithms.
Department of Urology, Rennes University Hospital, CHU Pontchaillou, rue Henri Le Guilloux, 35033 Rennes, France. jean-jacques.patard@chu-rennes.fr
Jean-Jacques
JJ
Patard
Emmanuelle
E
Leray
Luca
L
Cindolo
Vincenzo
V
Ficarra
Alejandro
A
Rodriguez
Alexandre
A
De La Taille
Jacques
J
Tostain
Walter
W
Artibani
Clement C
CC
Abbou
François
F
Guillé
Dominique K
DK
Chopin
Bernard
B
Lobel
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000145:classification* / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D002648:Child; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate