Giacomo Musso, Margaret F Meagher, Kit L Yuen, Benjamin Baker, Omer Baker, Aaron Ahdoot, Dhruv Puri, Mai Dabbas, Natalie Birouty, Cesare Saitta, Melis Guer, Dattatraya Patil, Hajime Tanaka, Masaki Kobayashi, Shohei Fukuda, Francesco Montorsi, Alberto Briganti, Andrea Salonia, Umberto Capitanio, Alessandro Larcher, Yasuhisa Fujii, Viraj Master, Ithaar H Derweesh
{"title":"副肿瘤和症状评分（PRIMAL）用于预测肾细胞癌患者手术后的总体和癌症特异性生存。","authors":"Giacomo Musso, Margaret F Meagher, Kit L Yuen, Benjamin Baker, Omer Baker, Aaron Ahdoot, Dhruv Puri, Mai Dabbas, Natalie Birouty, Cesare Saitta, Melis Guer, Dattatraya Patil, Hajime Tanaka, Masaki Kobayashi, Shohei Fukuda, Francesco Montorsi, Alberto Briganti, Andrea Salonia, Umberto Capitanio, Alessandro Larcher, Yasuhisa Fujii, Viraj Master, Ithaar H Derweesh","doi":"10.1016/j.urolonc.2025.03.022","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To develop the PRIMAL (Prognostic Risk stratification for Integrating Manifestations of symptoms and Abnormal Labs) score to predict prognosis in renal cell carcinoma (RCC) by integrating clinical presentation, paraneoplastic syndromes (PNS), and abnormal laboratory values at diagnosis.</p><p><strong>Materials and methods: </strong>5256 T1-T4, N0/1, M0/1 RCC surgical patients from 4 institutions were analyzed retrospectively. Preoperative variables included hematuria, visceral pain, nausea/vomiting, thrombocytopenia (<100 × 10<sup>9</sup>/L), hypoalbuminemia (<3.5 g/dL), anemia (<11.5 mg/dL for women, <12.5 mg/dL for men), elevated De Ritis Ratio (AST/ALT > 1.25), elevated neutrophil-to-lymphocyte-ratio (NLR > 2.27). Patients were stratified into 4 PRIMAL categories (Low = 0, Favorable-intermediate = 1-2, Unfavorable-intermediate = 1-2+anemia, High ≥ 3). Multivariable Cox regression and Kaplan-Meier analyses assessed association with overall survival (OS) and cancer-specific survival (CSS). C-indexes, Receiver operating characteristic curves and Area under curve assessed accuracy of the model towards OS and CSS individually and in combination with the Leibovich score.</p><p><strong>Results: </strong>2513 (48%) patients had low, 1532 (29%) favorable-intermediate, 909 (17%) unfavorable-intermediate, 302 (6%) high PRIMAL score. High score patients exhibited highest hazard ratios (HR) for all-cause mortality (ACM) (HR = 7.71, 95% CI = 5.98-9.93) and cancer-specific mortality (CSM) (HR = 8.54, 95% CI = 5.96-12.24). Five-year OS rates were 91%, 82%, 65% and 46%, while CSS rates were 95%, 90%, 76% and 60% for Low, Favorable-Intermediate, Unfavorable-Intermediate and High groups, respectively. PRIMAL achieved C-indexes of 0.70 for OS and 0.74 for CSS prediction. The combined CSS PRIMAL-Leibovich model yielded an AUC of 0.76 (P = 0.02), outperforming individual scores.</p><p><strong>Conclusion: </strong>PRIMAL is a valuable tool for RCC prognostication, enabling assessment of disease aggressiveness at diagnosis. Including PRIMAL score during initial evaluations enhances stratification, identifying patients with a higher risk disease and aids clinical decision-making.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Paraneoplastic and symptomatic score (PRIMAL) for prediction of overall and cancer-specific survival after surgery in patients with renal cell carcinoma.\",\"authors\":\"Giacomo Musso, Margaret F Meagher, Kit L Yuen, Benjamin Baker, Omer Baker, Aaron Ahdoot, Dhruv Puri, Mai Dabbas, Natalie Birouty, Cesare Saitta, Melis Guer, Dattatraya Patil, Hajime Tanaka, Masaki Kobayashi, Shohei Fukuda, Francesco Montorsi, Alberto Briganti, Andrea Salonia, Umberto Capitanio, Alessandro Larcher, Yasuhisa Fujii, Viraj Master, Ithaar H Derweesh\",\"doi\":\"10.1016/j.urolonc.2025.03.022\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To develop the PRIMAL (Prognostic Risk stratification for Integrating Manifestations of symptoms and Abnormal Labs) score to predict prognosis in renal cell carcinoma (RCC) by integrating clinical presentation, paraneoplastic syndromes (PNS), and abnormal laboratory values at diagnosis.</p><p><strong>Materials and methods: </strong>5256 T1-T4, N0/1, M0/1 RCC surgical patients from 4 institutions were analyzed retrospectively. Preoperative variables included hematuria, visceral pain, nausea/vomiting, thrombocytopenia (<100 × 10<sup>9</sup>/L), hypoalbuminemia (<3.5 g/dL), anemia (<11.5 mg/dL for women, <12.5 mg/dL for men), elevated De Ritis Ratio (AST/ALT > 1.25), elevated neutrophil-to-lymphocyte-ratio (NLR > 2.27). Patients were stratified into 4 PRIMAL categories (Low = 0, Favorable-intermediate = 1-2, Unfavorable-intermediate = 1-2+anemia, High ≥ 3). Multivariable Cox regression and Kaplan-Meier analyses assessed association with overall survival (OS) and cancer-specific survival (CSS). C-indexes, Receiver operating characteristic curves and Area under curve assessed accuracy of the model towards OS and CSS individually and in combination with the Leibovich score.</p><p><strong>Results: </strong>2513 (48%) patients had low, 1532 (29%) favorable-intermediate, 909 (17%) unfavorable-intermediate, 302 (6%) high PRIMAL score. High score patients exhibited highest hazard ratios (HR) for all-cause mortality (ACM) (HR = 7.71, 95% CI = 5.98-9.93) and cancer-specific mortality (CSM) (HR = 8.54, 95% CI = 5.96-12.24). Five-year OS rates were 91%, 82%, 65% and 46%, while CSS rates were 95%, 90%, 76% and 60% for Low, Favorable-Intermediate, Unfavorable-Intermediate and High groups, respectively. PRIMAL achieved C-indexes of 0.70 for OS and 0.74 for CSS prediction. The combined CSS PRIMAL-Leibovich model yielded an AUC of 0.76 (P = 0.02), outperforming individual scores.</p><p><strong>Conclusion: </strong>PRIMAL is a valuable tool for RCC prognostication, enabling assessment of disease aggressiveness at diagnosis. Including PRIMAL score during initial evaluations enhances stratification, identifying patients with a higher risk disease and aids clinical decision-making.</p>\",\"PeriodicalId\":23408,\"journal\":{\"name\":\"Urologic Oncology-seminars and Original Investigations\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-04-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urologic Oncology-seminars and Original Investigations\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.urolonc.2025.03.022\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urologic Oncology-seminars and Original Investigations","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.urolonc.2025.03.022","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Paraneoplastic and symptomatic score (PRIMAL) for prediction of overall and cancer-specific survival after surgery in patients with renal cell carcinoma.
Purpose: To develop the PRIMAL (Prognostic Risk stratification for Integrating Manifestations of symptoms and Abnormal Labs) score to predict prognosis in renal cell carcinoma (RCC) by integrating clinical presentation, paraneoplastic syndromes (PNS), and abnormal laboratory values at diagnosis.
Materials and methods: 5256 T1-T4, N0/1, M0/1 RCC surgical patients from 4 institutions were analyzed retrospectively. Preoperative variables included hematuria, visceral pain, nausea/vomiting, thrombocytopenia (<100 × 109/L), hypoalbuminemia (<3.5 g/dL), anemia (<11.5 mg/dL for women, <12.5 mg/dL for men), elevated De Ritis Ratio (AST/ALT > 1.25), elevated neutrophil-to-lymphocyte-ratio (NLR > 2.27). Patients were stratified into 4 PRIMAL categories (Low = 0, Favorable-intermediate = 1-2, Unfavorable-intermediate = 1-2+anemia, High ≥ 3). Multivariable Cox regression and Kaplan-Meier analyses assessed association with overall survival (OS) and cancer-specific survival (CSS). C-indexes, Receiver operating characteristic curves and Area under curve assessed accuracy of the model towards OS and CSS individually and in combination with the Leibovich score.
Results: 2513 (48%) patients had low, 1532 (29%) favorable-intermediate, 909 (17%) unfavorable-intermediate, 302 (6%) high PRIMAL score. High score patients exhibited highest hazard ratios (HR) for all-cause mortality (ACM) (HR = 7.71, 95% CI = 5.98-9.93) and cancer-specific mortality (CSM) (HR = 8.54, 95% CI = 5.96-12.24). Five-year OS rates were 91%, 82%, 65% and 46%, while CSS rates were 95%, 90%, 76% and 60% for Low, Favorable-Intermediate, Unfavorable-Intermediate and High groups, respectively. PRIMAL achieved C-indexes of 0.70 for OS and 0.74 for CSS prediction. The combined CSS PRIMAL-Leibovich model yielded an AUC of 0.76 (P = 0.02), outperforming individual scores.
Conclusion: PRIMAL is a valuable tool for RCC prognostication, enabling assessment of disease aggressiveness at diagnosis. Including PRIMAL score during initial evaluations enhances stratification, identifying patients with a higher risk disease and aids clinical decision-making.
期刊介绍：
Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
