Research in Context

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Multimodal recurrence scoring in localised clear cell renal cell carcinoma.

A retrospective multicentre validation study reports that a histopathological, genomic, and clinical scoring system predicted recurrence risk after surgery more accurately than TNM staging and established single-modality systems in independent Chinese cohorts and TCGA data.

  • Cheng-Peng Gui, MD; Yu-Hang Chen, MD; Hong-Wei Zhao, MD; Jia-Zheng Cao, MD; Tian-Jie Liu, PhD; Sheng-Wei Xiong, MD; et al.

  • June 23, 2023

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Evidence before this study

We searched PubMed with the search terms “renal cell carcinoma”, “RCC”, “prognostic model”, and “multimodal” for articles published in English between Jan 1, 2010, and Aug 28, 2022. We identified several studies in which multimodal prognostic models of renal cell carcinoma were built using histopathological whole-slide images (WSIs) and molecular profile data with The Cancer Genome Atlas (TCGA) dataset. However, the molecular signatures of previous models were developed based on analysis of fresh-frozen specimens in the TCGA set, and none of these models has been validated in multiple independent cohorts.

Added value of this study

In this study, we developed a recurrence scoring system that integrated three modalities—histopathological (the WSI-based score), genomic (the six single nucleotide polymorphism-based score), and clinical (the Leibovich score)—to predict the outcomes of renal cell carcinoma. This multimodal system was validated in independent sets from multicentres of China and the TCGA dataset. Our multimodal system can predict the recurrence risk of localised renal cell carcinoma more accurately than the existing TNM staging system and three established single-modality systems. The recurrence risk of patients with low stage or grade is usually lower than that of patients with high stage or grade; however, our results show that the recurrence risk of the patient subgroup with multimodal system-defined high risk in stage I or II disease was higher than in that with multimodal system-defined low risk in stage III, and that the recurrence risk of the patient subgroup with high risk in grade 1 or 2 was higher than in that with low risk in grade 3 or 4.

Implications of all the available evidence

To our knowledge, this study is the largest in the scientific literature to use a systematic approach to identify prognostic biomarkers for renal cell carcinoma. This assay is directly applicable to routinely available paraffin-embedded tumour tissue and haematoxylin and eosin-stained sections, which makes it easy to translate to clinical application. Our multimodal recurrence scoring system can be a practical and reliable prognostic tool for localised renal cell carcinoma, which can complement the existing staging system to predict recurrence after surgery and support more informed treatment decisions and trials of adjuvant therapy.

Source: The Lancet Digital Health

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