Renal malignancy recurrence can be accurately predicted by clinical factors

מתוך medicontext.co.il

WESTPORT, CT (Reuters Health) – Using patient symptoms
at presentation and clinical tumor size, researchers developed a biostatistical model that accurately stratifies patients with nonmetastatic renal cell carcinoma according to risk of recurrence. The use of this model could result in less invasive and less toxic treatments for patients deemed to be at low risk, the researchers suggest.

Dr. William W. Roberts of the Johns Hopkins Medical Institutions in Baltimore and colleagues analyzed the clinical and pathologic data for 296 patients who underwent surgery for renal cancer between 1990 and 1999. During a median follow-up of 48 months, 38 patients developed recurrences.

Using backward stepwise logistic regression analysis, the authors identified presentation and clinical size as two variables that explained clinically important differences in the risk of recurrence.

Presentation was scored as 0 for patients who were asymptomatic and 1 for patients with symptoms such as pain, hematuria, abdominal mass, or weight loss. Clinical tumor size was expressed in centimeters. Using their equation, Dr. Roberts' group found that a score of 3.0 or lower was considered to indicate low risk of recurrence.

Altogether, 79% of patients were identified as low risk according to the clinical variables, compared with 45% of those classified according to pathologic stage. The separation between the high- and low-risk survival curves was greater for those stratified clinically than those stratified pathologically.

If internally validated, use of this model can be used to predict which patients are at lower risk of recurrence. According to Dr. Roberts' team, these patients will be candidates for minimally invasive treatments for renal malignancy, such as ablative modalities or laparoscopic nephrectomy using morcellation. In addition, the investigators write, low-risk patients may need less rigorous surveillance postoperatively and may be able to bypass adjuvant treatment.

Urology 2001;58:141-145.

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