Brachytherapy for isolated vaginal recurrences from endometrial carcinoma

AIMS AND BACKGROUND: Isolated vaginal recurrences of endometrial carcinoma are rare, and prognostic factors that predict treatment outcome are still not well defined. The aim of the present study was to evaluate the results of brachytherapy in isolated vaginal recurrences from endometrial carcinoma. METHODS: Thirty-five patients with isolated vaginal recurrences were treated with brachytherapy with intravaginal ovoids or cylinders that were calculated to deliver 6000 to 7000 cGy at the surface. Patients were assessed for size and location of recurrence at presentation, response and complications from therapy. RESULTS: Treatment was well tolerated by most patients. Grade 2 toxicity occurred in 4 patients (3 cases of partial vaginal stenosis and one proctitis). Complete response to radiation was observed in all patients, and an overall 9 failures were observed (4 local, 4 distant and 1 local plus distant). Twenty patients (57%) were alive without evidence of disease at 3 to 11 years following treatment. Site of vaginal recurrence (upper third versus others) and long (more than 12 months versus less than 12 months) interval from hysterectomy were the only factors significantly related to local failures. CONCLUSIONS: Isolated vaginal recurrences following hysterectomy for endometrial carcinoma can be treated with brachytherapy with a low rate of severe toxicity.     

2009年国际妇产科联盟子宫内膜癌分期标准对磁共振成像分期诊断价值的影响

目的 分析2009年国际妇产科联盟(FIGO)分期的变化,探讨新版分期标准下磁共振成像(MRI)对子宫内膜癌的诊断价值。方法 分析63例经术后病理证实的子宫内膜癌初治患者的MRI 资料,对比在2009和1988年FIGO分期标准下,MRI对各期子宫内膜癌的诊断价值。结果 2009年FIGO分期中,将肿瘤局限于内膜和侵犯深度＜1/2肌层合并为Ⅰa期;将侵犯深度＞1/2肌层重新定义为Ⅰb期;仅有宫颈腺体受累归为Ⅰ期;删除了腹水或腹腔冲洗液中有癌细胞这一分期标准。以1988年FIGO分期为标准,MPI对Ⅰa期、Ⅰb期、Ⅰc期、Ⅰ期、Ⅱa期、Ⅱb期、Ⅱ期、Ⅲa期、Ⅲb期、Ⅲc 期、Ⅲ期和Ⅳb期诊断的准确率分别为95.2％、79.4％、81.0％、84.1％、96.8％、90.5％、90.5％、92.1％、98.4％、92.1％、82.5％和98.4％。以2009年FIGO分期为标准,MR]对Ⅰa期、Ib期、I期、Ⅱ期、Ⅲa期、Ⅲb期、Ⅲc期、Ⅲ期和Ⅳb期诊断的准确率分别为88.9％、81.0％、88.9％、92.1％、98.4％、98.4％、92.1％、88.9％和98.4％。结论2009年FIGO分期标准在1988年FIGO分期的基础上进行简化,使MRI评价Ⅰ～Ⅲ期子宫内膜癌的准确率有不同程度地提高,并进一步增加了子宫内膜癌术前分期的可靠性。     

Lymphadenectomy increases the prognostic value of the revised 2009 FIGO staging system for endometrial cancer: A multi-center study

Background

We investigated whether pelvic or para-aortic lymphadenectomy increases the prognostic value of the revised 2009 FIGO staging system in patients with endometrial cancer (EC).

Methods

We reviewed 786 patients with EC from six tertiary medical centers between July 1996 and June 2008. All patients were classified according to the 1988 FIGO staging system: IA (n = 234); IB (n = 270); IC (n = 109); IIA (n = 35); IIB (n = 29); IIIA (n = 37); IIIB (n = 3); IIIC (n = 69), and the revised 2009 FIGO staging system was also applied to divide them: IA (=542); IB (=125); II (n = 29); IIIA (n = 18); IIIB (n = 3); IIIC1 (n = 43); IIIC2 (n = 26). Prognostic values between the 1988 and the revised 2009 FIGO staging systems were compared by multivariate Cox’s proportional hazard analysis.

Results

The 1988 FIGO stage IC, IIB, IIIA + IIIB and IIIC, and the revised 2009 FIGO stage IB, II, IIIA + IIIB and IIIC2 diseases were prognostic factors for poor PFS, whereas the 1988 FIGO stage IIB and IIIC, and the revised 2009 FIGO stage II, IIIA + IIIB and IIIC2 diseases were unfavorable prognostic factors for OS. Although these results were similar to those in 595 patients who underwent pelvic or para-aortic lymphadenectomy, the revised 2009 FIGO stage IIIC1 disease was an additional prognostic factor for poor PFS and OS (adjusted HRs, 4.19 and 11.25; 95% CIs, 1.39–12.60 and 2.23–36.74).

Conclusions

The revised 2009 FIGO staging system had a higher prognostic value than the 1988 FIGO staging system, and pelvic or para-aortic lymphadenectomy increased the prognostic value of the revised 2009 FIGO staging system for EC.     

67例子宫内膜癌临床与手术分期的对比分析

目的 探讨子宫内膜癌临床与手术分期的临床意义。方法 对我院初治选择手术治疗的67例子宫内膜癌患的临床与手术病理资料进行回顾性分析，对临床分期与手术分期进行比较，并就手术方式进行探讨。结果 两不符合率为28．36％。临床Ⅰ期为21．42％(12／56)，Ⅱ期为66．67％(6／9)、Ⅲ期为50．00％(1／2)；病理类型、组织学分级手术前后总的误差率均为29．85％。临床Ⅰ期中，淋巴结转移率为1．78％，肌层浸润占73．2l％、腹腔细胞学检查阳性率为23．79％；临床Ⅱ期中，淋巴结转移率为28．57％(2／7)、肌层浸润占88．89(8／9)、腹腔细胞学阳性率为33．33％(2／6)。结论 手术分期较真实地反映了病变范围和病理特性，能客观判断预后，并指导治疗。     

Small-cell carcinoma of the lung: derivation of a prognostic staging system.

Retrospective data on 22 pretreatment attributes were evaluated in 614 patients with small-cell carcinoma of the lung (SCCL). The series included 284 patients with limited disease (LD) and 328 patients with extensive disease (ED) managed between 1974 and 1986. Prognostic factors were evaluated by univariate analysis and by the Cox multivariate regression model. Recursive partition and amalgamation algorithm (RECPAM), two clustering methods well suited for obtaining strata and adapted for censoring survival data, were developed and used in the formulation of a new prognostic staging system. In univariate analysis, prognosis was significantly influenced by extent of disease (DE), the number of metastatic sites, and the detection of mediastinal spread in LD. Poor performance status (PS), male sex, and advanced age were negatively correlated with survival, as were increased serum levels of alkaline phosphates (AP), lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA), total WBC count (WBCC), and low platelet count and low serum sodium. The Cox model identified plasma LDH and mediastinal spread as the only significant factors in LD; the influence of PS, number of metastatic sites, bone metastasis, brain metastasis, and platelet count were identified as significant in ED. The RECPAM model identified four distinct risk groups defined in a classification tree by the following eight attributes: DE, PS, serum AP, serum LDH, mediastinal spread, sex, WBCC, and liver metastasis. The four groups were distinguished by median survival times of 59, 49, 35, and 24 weeks, respectively (P = .0001). Interactions among prognostic factors are emphasized in the RECPAM classification model as evidenced by reassignment of patients across conventional staging barriers into alternate prognostic groups. The advantages of using RECPAM over the more conventional Cox regression techniques for a new staging system are discussed.     

Isolated vaginal recurrences of endometrial adenocarcinoma and their management

Eighteen patients with isolated vaginal recurrence of their previously treated endometrial carcinoma were treated with radiation therapy at North Carolina Baptist Hospital, Winston-Salem between 1971 and 1982. Most patients received external beam irradiation which were followed by boost treatments that were delivered with external beam (two patients) or intravaginal ovoid (11 patients). A local control rate of 44.4% with a 3-year minimum follow-up was obtained. Currently 33% are alive without evidence of disease 3 to 10 years following treatment. The most important prognostic indicator of outcome was size of vaginal recurrence. Of seven evaluable patients with tumors smaller than 2 cm there was one local failure. In contrast there were eight local failures in ten patients treated for tumors larger than 2 cm. Close follow-up and prompt diagnosis will enhance the chance of cure in endometrial cancer patients who do have recurrences.     

Definitive radiotherapy in the management of isolated vaginal recurrences of endometrial cancer

PURPOSE: The aim of our study was to assess prognostic factors and overall survival after salvage radiotherapy for patients who had endometrial carcinoma and who experienced an isolated vaginal recurrence. METHODS AND MATERIALS: We reviewed the records of 50 patients treated at our institution between 1967 and 2003 for an isolated vaginal recurrence of endometrial carcinoma. Initial treatment for endometrial carcinoma was definitive surgery in 49 patients and definitive radiotherapy in 1 patient. The median time from initial diagnosis of endometrial carcinoma to recurrence was 25 months (range, 4-179 months). Three patients (6%) received external-beam radiotherapy alone, 8 patients (16%) received brachytherapy only, and 39 patients (78%) received combined external-beam radiation therapy and brachytherapy. Median dose of radiation to the recurrence was 60 Gy (range, 16-85 Gy). Overall survival was calculated by the Kaplan-Meier method. Endpoints were measured from the date of diagnosis of the vaginal recurrence. Median follow-up of survivors after recurrence was 53 months (range, 8-159 months). RESULTS: The 5-year and 10-year disease-free and overall survivals were 68% and 55%, and 53% and 40%, respectively. On multivariate analysis, age (p = 0.0242), Grade 1 or 2 vs. Grade 3 tumor (p = 0.002), and size of recurrence (p < 0.001) were significant predictors of overall survival. All patients who had Grade 3 disease were dead by 3.6 years from the time of recurrence. Five patients experienced a Grade 3 or 4 complication. CONCLUSIONS: Patients treated with radiotherapy for an isolated vaginal recurrence can be cured in over 50% the cases. Radiotherapy is well tolerated, with a low risk of complications. Factors predictive of overall survival include tumor grade, patient age at recurrence, and tumor size.     

Clinical implications and prognostic value of five biomarkers in endometrial carcinoma

Objective

The aim was to identify the relationship between ER, PR, P53, Ki-67, PTEN, the association with clinicopathological parameters and the correlation with survival.

Methods

We studied 190 cases of primary endometrial carcinoma in which ER, PR, Ki-67, P53, PTEN antigens were investigated with the use of immunohistochemical methods. To evaluate the correlations among immunohistochemical staining and the age, menopause status, histological type, FIGO stage, grading, depth of invasion, lymph nodes involvement and serum tumor marker. Survival analysis was assessed within single and combined biomarkers types.

Results

The percentage of Ki-67 and P53 positive endometrial tumors was significantly higher in ER negative vs ER positive tumors (both P = 0.000). The same trend was evident in PR positive and negative group. The percentage of PTEN positive tumors was significantly higher in PR positive versus PR negative tumors (P = 0.021) but was no difference in different ER status. ER and PR status were significant predictors with FIGO staging, grading and recurrence. There was no clear association between PTEN positivity and clinicopathological parameters except more relevance with endometrioid histotype (P = 0.013). Positive Ki-67 or P53 was found to be strictly related to more aggressive features. There was statistically significant difference in different status of P53 and Ki-67 in survival time.

Conclusion

ER and PR positive tumors showed a statistically significant association with better clinical outcome, PR has more significant influence on prognosis. The percentage of positive Ki-67 or P53 was significantly higher in hormone-independent group versus in hormone-dependent group and combined Ki-67 and P53 may have more effect on prognosis in former group.     

Retropharyngeal lymph node metastasis in nasopharyngeal carcinoma: prognostic value and staging categories.

PURPOSE: To investigate the incidence, prognostic value, and staging categories of retropharyngeal lymph node (RLN) metastasis in nasopharyngeal carcinoma (NPC). EXPERIMENTAL DESIGN: We did a retrospective review of the data from 749 biopsy-proved nonmetastatic NPC patients. All patients had undergone contrast-enhanced computed tomography and had radiotherapy as their primary treatment. RESULTS: The incidence of RLN metastasis was 51.5%. After adjusting for tumor (T) and node (N) classifications, a borderline significant difference of distant metastasis-free survival (DMFS) rates was observed between patients with or without RLN metastasis. In N(0) disease, the presence of RLN metastasis was a significant independent predictor for overall survival (OS), loco-regional relapse-free survival, and DMFS in multivariate Cox modeling analysis. No significant difference was observed in all end points between patients with unilateral and bilateral RLN metastasis. The hazard ratios of death and distant failure for N(0) with RLN metastasis were similar to N(1). The survival curve of OS and DMFS for N(0) disease with RLN metastasis had approximated that of N(1) disease. The survival curve of OS for T(1) disease with RLN metastasis was approximately the same as T(2) disease. However, the survival curve of DMFS for T(1) disease with RLN metastasis was approximately the same as in T(3) disease. CONCLUSIONS: RLN metastasis has a tendency to affect the DMFS rates of patients with NPC. Retropharyngeal node involvement has a negative effect on the prognosis of N(0) disease. RLN metastasis should be classified as N(1).     

Retropharyngeal lymph node metastasis in nasopharyngeal carcinoma detected by magnetic resonance imaging : prognostic value and staging categories

BACKGROUND: Retropharyngeal lymph node (RLN) metastasis was not included in the current American Joint Committee on Cancer (AJCC) staging system (6th edition) for nasopharyngeal carcinoma (NPC).The object of the current study was to investigate the prognostic value and staging categories of RLN metastasis in NPC detected by magnetic resonance imaging (MRI). METHODS: All 924 consecutive patients with newly diagnosed NPC were examined with MRI before treatment with definitive intent radiotherapy. RESULTS: The incidence of RLN metastasis was 73.5%. On multivariate analysis, RLN metastasis was found to be an independent prognostic factor for distant metastasis-free survival (DMFS) in all patients (P = .040). In patients with N0 disease, significant differences were observed between patients with and those without RLN metastasis after adjusting for T classification (P = .046). With regard to laterality, no significant differences were observed in DMFS between patients with unilateral and bilateral RLN metastasis in N0 disease (P = .734). No significant difference in the hazards ratios for either DMFS or disease-free survival (DFS) was found between patients with N0 disease with RLN metastasis and patients with N1 disease (P = .092 and P = .149, respectively). When RLN was classified as N1 disease, there was a better segregation of different N classifications in terms of DFS and DMFS curves, whereas the difference in hazards ratios for N0 and N1 disease was more obvious in DMFS (from 0.461 vs 0.785 to 0.317 vs 0.690). CONCLUSIONS: The results of the current MRI-based study demonstrate that RLN metastasis affects the DMFS rates of NPC. The authors propose that RLN metastasis be classified as N1 disease, regardless of its laterality.     

A staging system for hepatocellular carcinoma: prognostic factors in Ugandan patients.

A staging scheme for hepatocellular carcinoma was presented at an International Symposium on Liver Cancer in Kampala, Uganda in 1971. Historical, clinical, and laboratory aspects of that staging scheme were examined for prognostic significance in 72 untreated patients with this disease studied at the Uganda Cancer Institute. The median survival for the entire group was 1 month. The presence of a serum bilirubin concentration of greater than 2 mg/100 ml or weight loss greater than 25 percent of body weight were the poorest prognostic features. Other factors with prognostic significance were visible abdominal collateral circulation, ascites, tumor differentiation, and serum levels of alkaline phosphatase, SGOT, alpha fetoprotein, and proline hydroxylase. A modified staging scheme is presented which defines three prognostically different groups of Ugandan patients. It is hoped this staging scheme will serve as a stimulus for analysis of similar prognostic features in other populations of patients with hepatocellular carcinoma.     

Prognostic value of the 7th edition of the AJCC staging system as a clinical staging system in patients with hepatocellular carcinoma

Background/Aims

In 2009, the American Joint Committee on Cancer (AJCC) published the 7th edition of the hepatocellular carcinoma (HCC) staging system. We investigated the prognostic value of the 7th AJCC staging system as a clinical staging system in patients with HCC.

Methods

We retrospectively applied the 6th and 7th AJCC systems to 877 patients who were diagnosed with HCC between January 2004 and December 2006 using radiological findings and compared the performance of the AJCC systems to that of the Barcelona Clinic Liver Cancer (BCLC) system. The prognostic power was quantified using a linear trend χ² test and -2 log likelihood.

Results

The median age was 57 years and males predominated (n = 701, 79.9%). There was no significant difference in survival between adjoining advanced stages of the 6th and 7th AJCC systems (?stage IIIA in the 6th and ?stage IIIB in the 7th; all p > 0.05), although a significant difference between adjoining early stages was identified. The 7th AJCC system had greater prognostic power than the 6th (linear trend χ² test, 168.195 versus 160.293; -2 log likelihood, 7366.347 versus 7396.380), but not greater than that of the BCLC system (linear trend χ² test = 207.013, -2 log likelihood = 7320.726).

Conclusions

The 7th AJCC staging system provided better prognostic power than the 6th for patients with HCC, but not better than that of the BCLC system. Thus, the 7th AJCC staging system should be applied cautiously in patients with advanced HCC because of its low prognostic power in advanced stages.     

磁共振成像在子宫内膜癌术前分期及肌层浸润深度判定中的作用(依照新修订的FIGO分期系统)

目的:评价在新修订的FIGO分期系统下,磁共振成像(magnetic resonance imaging,MRI)在子宫内膜癌术前分期及肌层浸润深度判定中的作用。方法:对36例子宫内膜癌进行术前MRI分期和肌层浸润深度判定,并与手术病理分期对照。结果:MRI术前分期诊断准确率为91.7%(33/36)。MRI诊断无肌层侵犯、浅肌层侵犯和深肌层侵犯的敏感性、特异性、准确率分别为50%、85.7%、77.8%;84.4%、76.5%、80.6%;80.0%、100%、94.4%。MRI区分Ⅰa期(无肌层侵犯和浅肌层侵犯)和Ⅰb期(深肌层浸润)的诊断准确率为94.4%(34/36)。结论:MRI对子宫内膜癌术前分期及肌层浸润深度的判断准确率较高,具有很高的应用价值。     

Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma

BACKGROUND:

Adrenocortical carcinoma (ACC) is a rare malignancy, and it was only in 2004 that the International Union Against Cancer (UICC) defined TNM criteria and published the first staging classification. However, to date, the prognostic value of the proposed classification has not been evaluated.

METHODS:

The German ACC Registry comprising 492 patients was searched for patients who were diagnosed between 1986 and 2007 with detailed information on primary diagnosis and a minimum follow‐up of 6 months. Patients were assigned to UICC tumor stage, and disease‐specific survival (DSS) was assessed. In addition, the contribution of potential risk factors for DSS was evaluated.

RESULTS:

In total, 416 patients with a mean follow‐up of 36 months met the inclusion criteria (stage I, n = 23 patients; stage II, n = 176 patients; stage III, n = 67 patients; stage IV, n = 150 patients). Kaplan‐Meier analysis revealed a stage‐dependent DSS. However, DSS in patients with stage II ACC did not differ significantly from DSS in patients with stage III ACC (hazard ratio, 1.38; 95% confidence interval, 0.89‐2.16). Furthermore, patients who had stage IV ACC without distant metastases had an improved DSS compared with patients who had metastatic disease (P = .004). An analysis of different potential risk factors for defining stage III ACC revealed important roles in DSS for tumor infiltration in surrounding tissue, venous tumor thrombus (VTT), and positive lymph nodes; whereas tumor invasion in adjacent organs carried a prognosis similar to that of infiltration in surrounding tissue only.

CONCLUSIONS:

The 2004 UICC staging classification for ACC has significant limitations. On the basis of the current analysis, a revised classification with superior prognostic accuracy is proposed (the European Network for the Study of Adrenal Tumors classification). In this system, stage III ACC is defined by the presence of positive lymph nodes, infiltration of surrounding tissue, or VTT; and stage IV ACC is restricted to patients with distant metastasis. Cancer 2009. © 2009 American Cancer Society.     

血清前白蛋白对原发性肝癌放射治疗预后分析

目的:分析放疗前血清前白蛋白(PAB)的水平对原发性肝癌(PLC)放射治疗预后的影响。方法:采用免疫比浊法测定64例原发性肝癌患者放疗前、中、后血清前白蛋白。结果:PAB正常者94.7%(36/38)完成放疗计划,放疗后3月、6月部分缓解率为:73.7%(28/38),81.6%(31/38);一年生存率为55.3%;PAB异常者仅61.5%(16/26)完成放疗计划,放疗后3月、6月部分缓解率为:38.5%(10/26),42.3%(11/26);一年生存率为30.8%。结论:血清前蛋白的测定对原发性肝癌放射治疗的计划制定及预后有指导意义。     

血清前白蛋白对原发性肝癌放射治疗预后分析

目的：分析放疗前血清前白蛋白（PAB）的水平对原发性肝癌（PLC）放射治疗预后的影响。方法：采用免疫比浊法测定64例原发性肝癌患者放疗前、中、后血清前白蛋白。结果：PAB正常者94.7%（36/38）完成放疗计划,放疗后3月、6月部分缓解率为：73.7%（28/38）,81.6%（31/38）;一年生存率为55.3%;PAB异常者仅61.5%（16/26）完成放疗计划,放疗后3月、6月部分缓解率为：38.5%（10/26）,42.3%（11/26）;一年生存率为30.8%。结论：血清前蛋白的测定对原发性肝癌放射治疗的计划制定及预后有指导意义。     

Interstitial brachytherapy for salvage treatment of vaginal recurrences in previously unirradiated endometrial cancer patients

PURPOSE: To evaluate whether interstitial brachytherapy can effectively salvage vaginal recurrence from endometrial carcinoma. METHODS AND MATERIALS: Between September 1989 and September 2000, 13 previously unirradiated patients (mean age 70 years) with isolated vaginal recurrences from endometrial adenocarcinoma were treated with interstitial low-dose-rate brachytherapy with or without additional external beam radiotherapy. Brachytherapy was delivered using a modified perineal Syed template loaded with (192)Ir. The central cylinder was loaded with high-activity (192)Ir (n = 12) or (137)Cs (n = 1). RESULTS: The patients had initially presented with FIGO Stage I (n = 11) or III (n = 2) cancer. Vaginal recurrences were diagnosed at a mean interval of 27.5 months after hysterectomy (range 2-83). The patients were followed for a median of 60 months (range 15-105). Ten patients had recurrence at the vaginal apex and three had recurrence in the lower two-thirds of the vagina. The median time to recurrence was 22 months. The tumor size ranged from 1.5 to 6 cm (mean 2.2, median 2.5). Eleven of 13 patients received 45-50-Gy pelvic external beam radiotherapy, followed by a mean interstitial brachytherapy boost of 28.3 Gy (range 18-35). The 2 other patients received brachytherapy only of 40 Gy and 50 Gy, respectively. All tumors were locally controlled. Three (23%) of 13 patients had a relapse at distant sites (two in the paraaortic region and one in the liver). The overall 8-year actuarial disease-specific survival rate was 77%. Major (Grade 3 and 4) long-term morbidity occurred in 2 patients (15%) and included Grade 3 vaginal ulceration in 1 patient, and Grade 4 colovesical fistula requiring surgical intervention in 1 patient. Additional long-term morbidity included Grade 2 proctitis in 1 patient. CONCLUSION: Interstitial brachytherapy with or without supplementary external beam radiotherapy can effectively salvage vaginal recurrence from endometrial cancer with very favorable local control and overall survival and acceptable morbidity.     

Validation by calibration of the UCLA integrated staging system prognostic model for nonmetastatic renal cell carcinoma after nephrectomy

BACKGROUND: To the authors' knowledge, calibration of the University of California at Los Angeles (UCLA) Integrated Staging System (UISS) prognostic score in patients nephrectomized for nonmetastatic renal cell carcinoma (RCC) has never been specifically addressed. The objective of the current study was to evaluate the calibration of the UISS prognostic score in a European multicenter retrospective study. METHODS: Six European centers participated in the study. According to the UISS, the endpoint was overall survival (OS). Survival curves were estimated by the Kaplan-Meier method. For calibration assessment, the approach of 'validation by calibration' first proposed by Van Houwelingen was used. The original prognostic score is embedded in a 'calibration model' that allows testing, in the validation cohort, the baseline hazards function as well the model linear predictor. Estimates of the 'calibration model' were used to recalibrate the UISS score. RESULTS: Of the 2471 available subjects, 399 had died of any cause within the first 5 years. The observed OS curves were compared with the corresponding expected model-based curves. The UISS model did not adequately predict OS, particularly in the extreme categories (P < .0001). Patients in the validation sample, indeed, fared systematically better than patients in the developing cohort. There was no evidence, instead, of a change in the relative effect of the prognostic covariates. After recalibration, the UISS score worked well in the validation cohort. CONCLUSIONS: The UISS score has good discrimination accuracy and is based on an adequately developed risk function. However, it systematically underestimates OS. At least in a European cohort of RCC patients, the use of the recalibrated UISS model could improve prediction accuracy.