Prognostic Significance of Grade Discrepancy Between Primary Tumor and Venous Thrombus in Nonmetastatic Clear-cell Renal Cell Carcinoma: Analysis of the REMEMBER Registry and Implications for Adjuvant Therapy

Zhenjie Wu¹, Hui Chen², Qi Chen³, Silun Ge⁴, Nengwang Yu⁵, Riccardo Campi⁶, Juan Gómez Rivas⁷, Riccardo Autorino⁸, Morgan Rouprêt⁹, Sarah P Psutka¹⁰, Reza Mehrazin¹¹, Francesco Porpiglia¹², Karim Bensalah¹³, Peter C Black¹⁴, Maria C Mir¹⁵, Andrea Minervini¹⁶, Hooman Djaladat¹⁷, Vitaly Margulis¹⁸, Riccardo Bertolo¹⁹, Anna Caliò²⁰, Umberto Carbonara²¹, Daniele Amparore²², Leonardo D Borregales²³, Chiara Ciccarese²⁴, Pietro Diana²⁵, Selcuk Erdem²⁶, Laura Marandino²⁷, Michele Marchioni²⁸, Constantijn H J Muselaers²⁹, Carlotta Palumbo³⁰, Nicola Pavan³¹, Angela Pecoraro³², Eduard Roussel³³, Hannah Warren³⁴, Savio Domenico Pandolfo³⁵, Rui Chen³⁶, Wenquan Zhou³⁷, Wei Zhai³⁸, Miaoxia He³⁹, Yaoming Li⁴⁰, Bo Han⁴¹, Jie Wan⁴², Xing Zeng⁴³, Junan Yan⁴⁴, Yao Fu⁴⁵, Changwei Ji⁴⁶, Xiang Fan⁴⁷, Guangyuan Zhang⁴⁸, Cheng Zhao⁴⁹, Taile Jing⁵⁰, Anbang Wang⁵¹, Chenchen Feng⁵², Hongwei Zhao⁵³, Di Sun⁵⁴, Liang Wang⁵⁵, Sheng Tai⁵⁶, Cheng Zhang⁵⁷, Shaohao Chen⁵⁸, Yixun Liu⁵⁹, Zhipeng Xu⁶⁰, Haifeng Wang⁶¹, Jinli Gao⁶², Fubo Wang⁶³, Jiwen Cheng⁶⁴, He Miao⁴, Qiu Rao², Jianning Wang⁶⁰, Ning Xu⁵⁸, Gongxian Wang⁵⁷, Chaozhao Liang⁵⁶, Zhiyu Liu⁵⁵, Dan Xia⁵⁰, Jun Jiang⁴⁰, Xiongbing Zu⁴⁹, Ming Chen⁴⁸, Hongqian Guo⁴⁶, Weijun Qin⁶⁵, Zhe Wang⁶⁶, Wei Xue³⁸, Benkang Shi⁵, Xiaojun Zhou², Shaogang Wang⁴³, Junhua Zheng³⁸, Jingping Ge³⁷, Xiang Feng⁶⁷, Minming Li⁶⁸, Cheng Chen⁶⁹, Le Qu⁷⁰, Linhui Wang⁷¹; REMEMBER Consortium and the European Association of Urology Young Academic Urologists Renal Cancer Working Group

Affiliations

¹ Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China; European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands. Electronic address: wuzhenjie17cz@gmail.com.
² Department of Pathology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China.
³ Department of Health Statistics, Naval Medical University, Shanghai, China.
⁴ Department of Urology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China.
⁵ Department of Urology, Qilu Hospital, Shandong University, Jinan, China.
⁶ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
⁷ Department of Urology, Hospital Clinico San Carlos, Madrid, Spain.
⁸ Department of Urology, Rush University Medical Center, Chicago, IL, USA.
⁹ Department of Urology, GRC No. 5, Predictive ONCO-URO, Hospital Pitié-Salpêtrière, AP-HP, Sorbonne University, Paris, France.
¹⁰ Department of Urology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA.
¹¹ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹² Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy.
¹³ Department of Urology, University of Rennes, Rennes, France.
¹⁴ Department of Urologic Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.
¹⁵ Department of Urology; Hospital Universitario La Ribera; Valencia, Spain.
¹⁶ Departments of Urology and Experimental and Clinical Medicine, University of Florence, Florence, Italy.
¹⁷ Institute of Urology, University of Southern California, Los Angeles, CA, USA.
¹⁸ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁹ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Urology Unit, San Carlo di Nancy Hospital, Rome, Italy.
²⁰ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
²¹ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.
²² European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy.
²³ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA.
²⁴ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
²⁵ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
²⁶ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urologic Oncology, Department of Urology, Istanbul University Faculty of Medicine, Istanbul, Turkey.
²⁷ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.
²⁸ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Medical, Oral and Biotechnological Sciences, Urology Unit, University G. d'Annunzio, Chieti, Italy.
²⁹ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
³⁰ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
³¹ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Urology Clinic, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy.
³² European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Pederzoli Hospital, Peschiera del Garda, Italy.
³³ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
³⁴ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Surgery and Interventional Science, University College London, London, UK.
³⁵ Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
³⁶ Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.
³⁷ Department of Urology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China.
³⁸ Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
³⁹ Department of Pathology, Changhai Hospital, Naval Medical University, Shanghai, China.
⁴⁰ Department of Urology, Daping Hospital, Army Medical University, Chongqing, China.
⁴¹ Department of Pathology, Qilu Hospital, Shandong University, Jinan, China.
⁴² Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴³ Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴⁴ Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China.
⁴⁵ Department of Pathology, Drum Tower Hospital, Clinical School of Nanjing University Medical College, Nanjing, China.
⁴⁶ Department of Urology, Drum Tower Hospital, Clinical School of Nanjing University Medical College, Nanjing, China.
⁴⁷ Department of Pathology, Zhongda Hospital, Southeast University, Nanjing, China.
⁴⁸ Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.
⁴⁹ Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
⁵⁰ Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁵¹ Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China.
⁵² Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.
⁵³ Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
⁵⁴ Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
⁵⁵ Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
⁵⁶ Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
⁵⁷ Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁵⁸ Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
⁵⁹ Department of Urology, Anhui Provincial Hospital/The First Hospital of the University of Science and Technology of China, Hefei, China.
⁶⁰ Department of Urology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
⁶¹ Department of Urology, Shanghai East Hospital, Tongji University, Shanghai, China.
⁶² Department of Pathology, Shanghai East Hospital, Tongji University, Shanghai, China.
⁶³ Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.
⁶⁴ Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
⁶⁵ Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
⁶⁶ Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
⁶⁷ Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China. Electronic address: 13621951368@163.com.
⁶⁸ Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China. Electronic address: limingmin421@sina.com.
⁶⁹ Department of Medical Oncology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China. Electronic address: chencheng1289@126.com.
⁷⁰ Department of Urology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China. Electronic address: septsoul@hotmail.com.
⁷¹ Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China. Electronic address: wanglinhui@smmu.edu.cn.

PMID: 37468393
DOI: 10.1016/j.euo.2023.06.006

Prognostic Significance of Grade Discrepancy Between Primary Tumor and Venous Thrombus in Nonmetastatic Clear-cell Renal Cell Carcinoma: Analysis of the REMEMBER Registry and Implications for Adjuvant Therapy

Zhenjie Wu et al. Eur Urol Oncol. 2024 Feb.

. 2024 Feb;7(1):112-121.

doi: 10.1016/j.euo.2023.06.006. Epub 2023 Jul 18.

Authors

Affiliations

¹ Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China; European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands. Electronic address: wuzhenjie17cz@gmail.com.
² Department of Pathology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China.
³ Department of Health Statistics, Naval Medical University, Shanghai, China.
⁴ Department of Urology, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Nanjing, China.
⁵ Department of Urology, Qilu Hospital, Shandong University, Jinan, China.
⁶ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
⁷ Department of Urology, Hospital Clinico San Carlos, Madrid, Spain.
⁸ Department of Urology, Rush University Medical Center, Chicago, IL, USA.
⁹ Department of Urology, GRC No. 5, Predictive ONCO-URO, Hospital Pitié-Salpêtrière, AP-HP, Sorbonne University, Paris, France.
¹⁰ Department of Urology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA, USA.
¹¹ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹² Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy.
¹³ Department of Urology, University of Rennes, Rennes, France.
¹⁴ Department of Urologic Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.
¹⁵ Department of Urology; Hospital Universitario La Ribera; Valencia, Spain.
¹⁶ Departments of Urology and Experimental and Clinical Medicine, University of Florence, Florence, Italy.
¹⁷ Institute of Urology, University of Southern California, Los Angeles, CA, USA.
¹⁸ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁹ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Urology Unit, San Carlo di Nancy Hospital, Rome, Italy.
²⁰ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
²¹ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.
²² European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy.
²³ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, NY, USA.
²⁴ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Medical Oncology Unit, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
²⁵ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
²⁶ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urologic Oncology, Department of Urology, Istanbul University Faculty of Medicine, Istanbul, Turkey.
²⁷ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.
²⁸ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Medical, Oral and Biotechnological Sciences, Urology Unit, University G. d'Annunzio, Chieti, Italy.
²⁹ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
³⁰ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
³¹ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Urology Clinic, Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy.
³² European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, Pederzoli Hospital, Peschiera del Garda, Italy.
³³ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
³⁴ European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands; Division of Surgery and Interventional Science, University College London, London, UK.
³⁵ Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
³⁶ Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.
³⁷ Department of Urology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China.
³⁸ Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
³⁹ Department of Pathology, Changhai Hospital, Naval Medical University, Shanghai, China.
⁴⁰ Department of Urology, Daping Hospital, Army Medical University, Chongqing, China.
⁴¹ Department of Pathology, Qilu Hospital, Shandong University, Jinan, China.
⁴² Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴³ Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴⁴ Department of Urology, Southwest Hospital, Army Medical University, Chongqing, China.
⁴⁵ Department of Pathology, Drum Tower Hospital, Clinical School of Nanjing University Medical College, Nanjing, China.
⁴⁶ Department of Urology, Drum Tower Hospital, Clinical School of Nanjing University Medical College, Nanjing, China.
⁴⁷ Department of Pathology, Zhongda Hospital, Southeast University, Nanjing, China.
⁴⁸ Department of Urology, Zhongda Hospital, Southeast University, Nanjing, China.
⁴⁹ Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
⁵⁰ Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁵¹ Department of Urology, Changzheng Hospital, Naval Medical University, Shanghai, China.
⁵² Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.
⁵³ Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
⁵⁴ Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
⁵⁵ Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
⁵⁶ Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
⁵⁷ Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
⁵⁸ Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
⁵⁹ Department of Urology, Anhui Provincial Hospital/The First Hospital of the University of Science and Technology of China, Hefei, China.
⁶⁰ Department of Urology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
⁶¹ Department of Urology, Shanghai East Hospital, Tongji University, Shanghai, China.
⁶² Department of Pathology, Shanghai East Hospital, Tongji University, Shanghai, China.
⁶³ Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, China.
⁶⁴ Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
⁶⁵ Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
⁶⁶ Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
⁶⁷ Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China. Electronic address: 13621951368@163.com.
⁶⁸ Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China. Electronic address: limingmin421@sina.com.
⁶⁹ Department of Medical Oncology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China. Electronic address: chencheng1289@126.com.
⁷⁰ Department of Urology, Jinling Hospital, Clinical School of Nanjing University Medical College, Nanjing, China. Electronic address: septsoul@hotmail.com.
⁷¹ Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China. Electronic address: wanglinhui@smmu.edu.cn.

PMID: 37468393
DOI: 10.1016/j.euo.2023.06.006

Abstract

Background: Further stratification of the risk of recurrence of clear-cell renal cell carcinoma (ccRCC) with venous tumor thrombus (VTT) will facilitate selection of candidates for adjuvant therapy.

Objective: To assess the impact of tumor grade discrepancy (GD) between the primary tumor (PT) and VTT in nonmetastatic ccRCC on disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS).

Design, setting, and participants: This was a retrospective analysis of a multi-institutional nationwide data set for patients with pT3N0M0 ccRCC who underwent radical nephrectomy and thrombectomy.

Outcomes measurements and statistical analysis: Pathology slides were centrally reviewed. GD, a bidirectional variable (upgrading or downgrading), was numerically defined as the VTT grade minus the PT grade. Multivariable models were built to predict DFS, OS, and CSS.

Results and limitations: We analyzed data for 604 patients with median follow-up of 42 mo (excluding events). Tumor GD between VTT and PT was observed for 47% (285/604) of the patients and was an independent risk factor with incremental value in predicting the outcomes of interest (all p < 0.05). Incorporation of tumor GD significantly improved the performance of the ECOG-ACRIN 2805 (ASSURE) model. A GD-based model (PT grade, GD, pT stage, PT sarcomatoid features, fat invasion, and VTT consistency) had a c index of 0.72 for DFS. The hazard ratios were 8.0 for GD = +2 (p < 0.001), 1.9 for GD = +1 (p < 0.001), 0.57 for GD = -1 (p = 0.001), and 0.22 for GD = -2 (p = 0.003) versus GD = 0 as the reference. According to model-converted risk scores, DFS, OS, and CSS significantly differed between subgroups with low, intermediate, and high risk (all p < 0.001).

Conclusions: Routine reporting of VTT upgrading or downgrading in relation to the PT and use of our GD-based nomograms can facilitate more informed treatment decisions by tailoring strategies to an individual patient's risk of progression.

Patient summary: We developed a tool to improve patient counseling and guide decision-making on other therapies in addition to surgery for patients with the clear-cell type of kidney cancer and tumor invasion of a vein.

Keywords: Adjuvant therapy; Downgrading; Model; Prognosis; Progression; Renal cell carcinoma; Tumor grade; Upgrading; Venous tumor thrombus.

PubMed Disclaimer

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- ClinicalKey
- Elsevier Science
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Prognostic Significance of Grade Discrepancy Between Primary Tumor and Venous Thrombus in Nonmetastatic Clear-cell Renal Cell Carcinoma: Analysis of the REMEMBER Registry and Implications for Adjuvant Therapy

Affiliations

Prognostic Significance of Grade Discrepancy Between Primary Tumor and Venous Thrombus in Nonmetastatic Clear-cell Renal Cell Carcinoma: Analysis of the REMEMBER Registry and Implications for Adjuvant Therapy

Authors

Affiliations

Abstract

MeSH terms

LinkOut - more resources

Full Text Sources

Medical