title: Increased expression of colony stimulating factor-1 is a predictor of poor prognosis in patients with clear-cell renal cell carcinoma.
abstract: BACKGROUND
  This study aims to evaluate the impact of colony stimulating factor-1 (CSF-1) expression on recurrence and survival of patients with clear-cell renal cell carcinoma (ccRCC) following surgery.
  
  
  METHODS
  We retrospectively enrolled 267 patients (195 in the training cohort and 72 in the validation cohort) with ccRCC undergoing nephrectomy at a single institution. Clinicopathologic features, cancer-specific survival (CSS) and recurrence-free survival (RFS) were recorded. CSF-1 levels were assessed by immunohistochemistry in tumor tissues. Kaplan-Meier method was applied to compare survival curves. Cox regression models were used to analyze the impact of prognostic factors on CSS and RFS. Concordance index (C-index) was calculated to assess predictive accuracy.
  
  
  RESULTS
  In both cohorts, CSF-1 expression positively correlated with advanced Fuhrman grade and necrosis. High CSF-1 expression indicated poor survival and early recurrence of ccRCC patients after surgery, especially those with advanced TNM stage disease. Multivariate Cox regression analysis showed CSF-1 expression was an independent unfavorable prognostic factor for recurrence and survival. The predictive accuracy of the University of California Los Angeles Integrated Staging System (UISS) was significantly improved when CSF-1 expression was incorporated.
  
  
  CONCLUSIONS
  High CSF-1 expression is a potential adverse prognostic biomarker for recurrence and survival of ccRCC patients after nephrectomy.
authors.affiliation: Key Laboratory of Glycoconjugate Research, MOH, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Shanghai Medical College of Fudan University, Mailbox 103, 138 Yixueyuan Road, Shanghai, 200032, China. yangliu729@sina.cn.
authors.forename: Liu
authors.initials: L
authors.lastname: Yang
authors.affiliation: Key Laboratory of Glycoconjugate Research, MOH, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Shanghai Medical College of Fudan University, Mailbox 103, 138 Yixueyuan Road, Shanghai, 200032, China. wqian04@163.com.
authors.forename: Qian
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. xule2010@gmail.com.
authors.forename: Le
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Immunology, School of Basic Medical Sciences, Shanghai Medical College of Fudan University, Shanghai, 200032, China. weijuanzhang@fudan.edu.cn.
authors.forename: Weijuan
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Urology, Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200011, China. ronniezhu001@gmail.com.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Key Laboratory of Glycoconjugate Research, MOH, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Shanghai Medical College of Fudan University, Mailbox 103, 138 Yixueyuan Road, Shanghai, 200032, China. liuhaiou@fudan.edu.cn.
authors.forename: Haiou
authors.initials: H
authors.lastname: Liu
authors.affiliation: Key Laboratory of Glycoconjugate Research, MOH, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Shanghai Medical College of Fudan University, Mailbox 103, 138 Yixueyuan Road, Shanghai, 200032, China. jjxufdu@fudan.edu.cn.
authors.forename: Jiejie
authors.initials: J
authors.lastname: Xu
authors.affiliation: Key Laboratory of Glycoconjugate Research, MOH, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Shanghai Medical College of Fudan University, Mailbox 103, 138 Yixueyuan Road, Shanghai, 200032, China. jxgu@shmu.edu.cn.
authors.forename: Jianxin
authors.initials: J
authors.lastname: Gu
mesh_terms: D002292:Carcinoma, Renal Cell / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D015141:Los Angeles; D016173:Macrophage Colony-Stimulating Factor / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000473:pathology*; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D016173:Macrophage Colony-Stimulating Factor