SIGNIFICANCE OF CONVENTIONAL AND NEW PROGNOSTIC FACTORS FOR LOCALLY CONFINED RENAL-CELL CARCINOMA

Background. The prognosis of patients with locally confined renal cell carcinoma is variable. To improve the prognostic knowledge and select patients at high risk, additional prognostic parameters are needed. M ethods. The significance with respect to survival and tumor recurrence of ''classic'' and ''new'' prognostic parameters has been examined by following 41 patients with locally confined renal cell carcinoma afte r nephrectomy (mean follow-up, 5.2 years). The significance of histolo gic grade, tumor stage, Ki-67 index, proliferating cell nuclear antige n index, H-3-thymidine labeling index, tumor ploidy status, and tumor growth after xenotransplantation into nude mice (GAX range) was tested using the Kaplan-Meier plots by the log rank test or Tarone's test an d also by the Cox multiple hazard regression analysis. Results. Tumor stage (P < 0.0025), histologic grade (P < 0.005), Ki-67 index (P < 0.0 06), and GAX range (P < 0.00004) were found to be significant prognost ic parameters for survival and tumor recurrence using single-factor an alysis. Applying the multivariate analysis, the combination of the ''n ew'' factors, GAX range and Ki-67 index, resulted in even a higher pro gnostic relevance than the combination of the ''classic'' prognostic f actors, tumor stage and histologic grade. The calculated prognostic in dex based on the results of the Cox analysis, which, except for stage and grade, included the Ki-67 index, was shown to be highly correlated with survival (P = 0.00002) and tumor recurrence (P = 0.0004). Its pr ognostic validity was studied with the receiver operating characterist icss procedure and was found to be considerably superior to that of th e two conventional prognosticators. Conclusions. The additional determ ination of the Ki-67 labeling index increases the prognostic assessmen t of patients with locally confined renal cell carcinoma.