title: Validation of a postoperative prognostic model consisting of tumor microvascular invasion, size, and grade to predict disease-free and cancer-specific survival of patients with surgically resected renal cell carcinoma.
abstract: OBJECTIVE
  To determine the value of microvascular invasion, tumor size, and Fuhrman grade to predict the survival of patients with surgically resected renal cell carcinoma (RCC).
  
  
  METHODS
  A total of 771 consecutive patients (T1-4, Nx, M0) were retrospectively reviewed. For each patient with RCC, the prognostic Sao Paulo score (SPS) was calculated using the following variables: tumor size (>7 cm vs <or=7 cm), nuclear grading, and microvascular invasion. On the basis of SPS, patients were subdivided into low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups. Disease-free survival (DFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Median follow-up was 80 months.
  
  
  RESULTS
  Median follow-up was 80 months. DFS rates after 5 years were 91.2%, 61.3%, and 51.9% in the original SPS LR, IR, and HR groups, respectively. CSS rates after 5 years were 94.3%, 79.8%, and 58.7%, respectively (P < 0.001). Each original SPS constituent revealed a significant influence on DFS and CSS in the multivariate analysis. By modification of the cut-off value of the maximum tumor size from 7 to 5 cm the predictive value of the SPS sum score was marginally enhanced. Using a cut-off value of 5 cm also resulted in a relatively better discrimination between the IR and the HR group regarding DFS and CSS.
  
  
  CONCLUSIONS
  Stratifying RCC patients by SPS into LR, IR, and HR groups provides a clinically useful tool for outcome analysis and risk assessment. However, the prognostic value of the SPS could be enhanced by including a maximum tumor size with a cut-off at 5 cm into the sum score.
authors.affiliation: Department of Urology, St. Elisabeth Klinikum Straubing, Straubing, Germany. matthias.may@klinikum-straubing.de
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.forename: Sabine
authors.initials: S
authors.lastname: Brookman-Amissah
authors.forename: Friederike
authors.initials: F
authors.lastname: Kendel
authors.forename: Nina
authors.initials: N
authors.lastname: Knoll
authors.forename: Jan
authors.initials: J
authors.lastname: Roigas
authors.forename: Bernd
authors.initials: B
authors.lastname: Hoschke
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
authors.forename: Christian
authors.initials: C
authors.lastname: Gilfrich
authors.forename: Sandra
authors.initials: S
authors.lastname: Pflanz
authors.forename: Oliver
authors.initials: O
authors.lastname: Gralla
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000469:parasitology / Q000601:surgery; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009392:Nephrectomy / Q000401:mortality*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis