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JU INSIGHT Mayo Clinic Validation of AUA Risk Groups for Renal Cell Carcinoma

By: Andrew Zganjar, MD, Mayo Clinic, Rochester, Minnesota; Abhinav Khanna, MD, Mayo Clinic, Rochester, Minnesota; Dan Joyce, MD, Mayo Clinic, Rochester, Minnesota; Paige Nichols, MD, Mayo Clinic, Rochester, Minnesota; Cameron Britton, MD, Mayo Clinic, Rochester, Minnesota; Christine M. Lohse, MS, Mayo Clinic, Rochester, Minnesota; John C. Cheville, MD, Mayo Clinic, Rochester, Minnesota; Sounak Gupta, MD, Mayo Clinic, Rochester, Minnesota; Aaron M. Potretzke, MD, Mayo Clinic, Rochester, Minnesota; R. Houston Thompson, MD, Mayo Clinic, Rochester, Minnesota; Bradley C. Leibovich, MD, Mayo Clinic, Rochester, Minnesota; Stephen A. Boorjian, MD, Mayo Clinic, Rochester, Minnesota; Vidit Sharma, MD, MS, Mayo Clinic, Rochester, Minnesota | Posted on: 14 Aug 2024

Zganjar A, Khanna A, Joyce D, et al. Mayo Clinic validation of the AUA risk groups for localized renal cell carcinoma. J Urol. 2024;212(2):331-341. doi:10.1097/JU.0000000000004030

Study Need and Importance

The AUA guidelines introduced a parsimonious risk stratification system of localized renal cell carcinoma (RCC) treated with surgery that relies on grade, stage, and margin status. The AUA guidelines recommend specific follow-up schedules for surveillance based on this risk stratification. However, the performance of this risk stratification system has not been validated. We queried our prospectively maintained Nephrectomy Registry to identify adults treated with radical or partial nephrectomy for unilateral, M0, clear cell RCC or papillary RCC from 1980 to 2012 to determine how the AUA risk groups stratified patients for progression-free survival (PFS) and cancer-specific survival (CSS). We also presented the results of our institutional models as a reference to gauge the relative performance of the simpler AUA risk stratification system.

What We Found

In a cohort of 3191 patients with clear cell RCC and 633 patients with papillary RCC, the C indexes for the AUA risk stratification system were 0.780 (clear cell RCC) and 0.775 (papillary RCC) when measuring PFS, and were 0.811 (clear cell RCC) and 0.830 (papillary RCC) when measuring CSS over 10 years. This performed similarly to our institutional models and stratified both clear cell and papillary RCC patients over 10 years postoperatively (Figure). These data support using the AUA RCC risk stratification system for the follow-up of surgically treated patients with localized renal masses.

Image

Figure. AUA risk group stratification for progression-free survival (PFS) of clear cell (A) or papillary (B) renal cell carcinoma (RCC) after surgery. HR indicates high-risk; IR, intermediate-risk; LR, low-risk; VHR, very high-risk.

Limitations

Our data suffer from the limitations of a single institution database that is retrospectively reviewed. Since the AUA risk groups incorporate grade, they are less applicable to chromophobe RCC.

Interpretation for Patient Care

The AUA risk grouping has acceptable discriminative value for PFS and CSS after radical or partial nephrectomy for clear cell or papillary RCC. This supports survivorship follow-up schedules based on this system as stated in the AUA guidelines.

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