Proposal for a Two-Tier Re-classification of Stage IV/M1 domain of Renal Cell Carcinoma into M1 (“Oligometastatic”) and M2 (“Polymetastatic”) subdomains: Analysis of the Registry for Metastatic Renal Cell Carcinoma (REMARCC)

Frontiers in Oncology

Oncology

Siska Van Bruwaene¹  Jose Rubio²  Maria C. Mir²  Estefania Linares³  Maurizio D’Anna⁴  Mireia Musquera⁴  Vital Hevia⁵  Tobias Klatte⁶  Alessandro Antonelli⁷  Carlotta Palumbo⁷  Matthias Heck⁸  Thomas Amiel⁸  Eduard Roussel⁹  Maarten Albersen⁹  Maximilian Kriegmair^1,10  Margaret F. Meagher^1,11  Cesare Saitta^1,11  Ithaar H. Derweesh^1,11  Jonathan Afari^1,11  Rana R. McKay^1,11  Franklin Liu^1,11  Riccardo Campi^1,12  Andrea Minervini^1,12  Andrea Mari^1,12  Nicola Pavan^1,13  Francesco Claps^1,13  Georgi Guruli^1,13  Enrico Checcucci^1,14  Francesco Porpiglia^1,14  Michele Marchioni^1,15  Riccardo Autorino^1,16  Alessandro Veccia^1,16 

[1] Department of Urology, AZ Groeninge, Kortrijk, Belgium;Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain;Department of Urology, Hospital 12 de Octubre, Madrid, Spain;Department of Urology, Hospital Clinic, Carrer de Villarroel, Barcelona, Spain;Department of Urology, Hospital Ramon y Cajal, Madrid, Spain;Department of Urology, Royal Bournemouth Hospital, Bournemouth, United Kingdom;Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy;Department of Urology, Technical University of Munich, Munich, Germany;Department of Urology, UK Leuven, Leuven, Belgium;Department of Urology, University Medical Centre Mannheim, Mannheim, Germany;Department of Urology, University of California (UC) San Diego School of Medicine, La Jolla, CA, United States;Department of Urology, University of Florence, Careggi Hospital, Florence, Italy;Department of Urology, University of Trieste, Trieste, Italy;Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Orbassano, Italy;Department of Urology, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy;Department of Urology, Virginia Commonwealth University (VCU) Medical Center, Richmond, VA, United States;

关键词: carcinoma, renal cell;    neoplasm metastasis;    neoplasm staging;    nephrectomy;    survival analysis;    TNM staging system;   

DOI  :  10.3389/fonc.2023.1113246

 received in 2022-12-01, accepted in 2023-01-12,  发布年份 2023

来源: Frontiers

【 摘 要 】

PurposeWe hypothesized that two-tier re-classification of the “M” (metastasis) domain of the Tumor-Node-Metastasis (TNM) staging of Renal Cell Carcinoma (RCC) may improve staging accuracy than the current monolithic classification, as advancements in the understanding of tumor biology have led to increased recognition of the heterogeneous potential of metastatic RCC (mRCC).MethodsMulticenter retrospective analysis of patients from the REMARCC (REgistry of MetAstatic RCC) database. Patients were stratified by number of metastases into two groups, M1 (≤3, “Oligometastatic”) and M2 (>3, “Polymetastatic”). Primary outcome was overall survival (OS). Secondary outcomes were cancer-specific survival (CSS). Cox-regression and Kaplan-Meier (KMA) analysis were utilized for outcomes, and receiver operating characteristic analysis (ROC) was utilized to assess diagnostic accuracy compared to current “M” staging.Results429 patients were stratified into proposed M1 and M2 groups (M1 = 286/M2 = 143; median follow-up 19.2 months). Cox-regression revealed M2 classification as an independent risk factor for worsened all-cause mortality (HR=1.67, p=0.001) and cancer-specific mortality (HR=1.74, p<0.001). Comparing M1-oligometastatic vs. M2-polymetastatic groups, KMA revealed significantly higher 5-year OS (36% vs. 21%, p<0.001) and 5-year CSS (39% vs. 17%, p<0.001). ROC analyses comparing OS and CSS, for M1/M2 reclassification versus unitary M designation currently in use demonstrated improved c-index for OS (M1/M2 0.635 vs. unitary M 0.500) and CSS (M1/M2 0.627 vs. unitary M 0.500).ConclusionSubclassification of Stage “M” domain of mRCC into two clinical substage categories based on metastatic burden corresponds to distinctive tumor groups whose oncological potential varies significantly and result in improved predictive capability compared to current staging.

【 授权许可】

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Copyright © 2023 Meagher, Mir, Minervini, Kriegmair, Heck, Porpiglia, Van Bruwaene, Linares, Hevia, D’Anna, Veccia, Roussel, Claps, Palumbo, Marchioni, Afari, Saitta, Liu, Rubio, Campi, Mari, Amiel, Checcucci, Musquera, Guruli, Pavan, Albersen, Antonelli, Klatte, Autorino, McKay and Derweesh