Renal Cancer pp 345-359 | Cite as

Outcomes: Prognostic Factors, Models, and Algorithms

  • Kristian D. StenslandEmail author
  • Michael W. Kattan


Renal cell carcinoma has a wide and varied clinical presentation and natural history, and this heterogeneity can be problematic when it comes to providing the individualized outcome predictions that contemporary patients crave. This heterogeneity, together with the cost and toxicity of both systemic and local therapies, underscores the need for prediction models and algorithms that can help to identify which patients will experience the most amount of therapeutic benefit and incur the least amount of treatment-related harm. Tumor stage and cellular characteristics were once considered the primary determinants of overall prognosis but have now become components of more refined clinical algorithms and nomograms that incorporate clinical, pathologic, and molecular data. These prediction tools have the capability to provide individualized risk estimations in an unbiased, reproducible, and evidence-based format, and currently, models have been constructed and validated in the preoperative, postoperative, and metastatic settings for RCC. As our understanding of the implications of molecular markers continues to develop, the incorporation of these variables into existing models should improve not only our selection of systemic therapies and clinical trials but also patient satisfaction and outcomes.


Algorithm Nomogram Outcomes Prediction tools Renal cancer 


  1. 1.
    Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell cancer in the United States. JAMA. 1999;281(17):1628–31.CrossRefPubMedGoogle Scholar
  2. 2.
    Hock LM, Lynch J, Balaji KC. Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of Surveillance, Epidemiology and End Results Program data. J Urol. 2002;167:57–60.CrossRefPubMedGoogle Scholar
  3. 3.
  4. 4.
    Janzen NK, Kim HL, Figlin RA, Belldegrun AS. Surveillance after radical or partial nephrectomy for localized renal cell carcinoma and management of recurrent disease. Urol Clin North Am. 2003;30(4):843–52.CrossRefPubMedGoogle Scholar
  5. 5.
    Mejean A, Ravaud A, Thezenas S, Colas S, Beauval JB, et al. Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N Engl J Med. 2018;379:417–27.CrossRefGoogle Scholar
  6. 6.
    Flocks RH, Kadesky MC. Malignant neoplasms of the kidney; an analysis of 353 patients followed five years or more. J Urol. 1958;79(2):196–201.CrossRefPubMedGoogle Scholar
  7. 7.
    Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. J Urol. 1969;101(3):297–301.CrossRefGoogle Scholar
  8. 8.
    Harmer M. TNM classification of malignant tumors. 2nd ed. Geneva: International Union Against Cancer; 1974.Google Scholar
  9. 9.
    Edge SB, Byrd DR, Compton CC, et al., editors. Kidney. In: AJCC cancer staging manual. 7th ed. New York: Springer; 2010. p 479–89.Google Scholar
  10. 10.
    Amin M, Edge S, Greene F, et al., editors. Kidney. In: AJCC cancer staging manual. 8th ed. New York: Springer; 2016.Google Scholar
  11. 11.
    Paner GP, Stadler WM, Hansel DE, Montironi R, Lin DW, Amin MB. Updates in the eighth edition of the tumor-node-metastasis staging classification for urologic cancers. Eur Urol. 2018;73(4):560–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Kim SP, Alt AL, Weight CJ, Costello BA, Cheville JC, Lohse C, Allmer C, Leibovich BC. Independent validation of the 2010 American Joint Committee on Cancer TNM classification for renal cell carcinoma: results from a large, single institution cohort. J Urol. 2011;185(6):2035–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Novara G, Ficarra V, Antonelli A, Artibani W, Bertini R, et al. Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: are further improvements needed? Eur Urol. 2010;58(4):588–95.CrossRefPubMedGoogle Scholar
  14. 14.
    Bretheau D, Lechevallier E, de Fromont M, Sault MC, Rampal M, Coulange C. Prognostic value of nuclear grade of renal cell carcinoma. Cancer. 1995;76(12):2543–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982;6(7):655–63.CrossRefPubMedGoogle Scholar
  16. 16.
    Moch H, Humphrey PA, Ulbright TM, Reuter VE. WHO classification of tumours of the urinary system and male genital organs. Geneva: WHO Press; 2016.Google Scholar
  17. 17.
    Dagher J, Delahunt B, Rioux-Leclercq N, et al. Clear cell renal cell carcinoma: validation of WHO/ISUP grading. Histopathology. 2017;71:918–25.CrossRefPubMedGoogle Scholar
  18. 18.
    Ficarra V, Righetti R, Martignoni G, D’Amico A, Pilloni S, Rubilotta E, Malossini G, Mobilio G. Prognostic value of renal cell carcinoma nuclear grading: multivariate analysis of 333 cases. Urol Int. 2001;67(2):130–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Lane BR, Kattan MW. Predicting outcomes in renal cell carcinoma. Curr Opin Urol. 2005;15:289–97.CrossRefPubMedGoogle Scholar
  20. 20.
    Kovacs G, Akhtar M, Beckwith BJ, Bugert P, Cooper CS, Delahunt B, Eble JN, Fleming S, Ljungberg B, Medeiros LJ, Moch H, Reuter VE, Ritz E, Roos G, Schmidt D, Srigley JR, Störkel S, van den Berg E, Zbar B. The Heidelberg classification of renal cell tumours. J Pathol. 1997;183(2):131–3.CrossRefGoogle Scholar
  21. 21.
    Klatte T, Han KR, Said JW, Böhm M, Allhoff EP, Kabbinavar FF, Belldegrun AS, Pantuck AJ. Pathobiology and prognosis of chromophobe renal cell carcinoma. Urol Oncol. 2008;26(6):604–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Amin MB, Tamboli P, Javidan J, Stricker H, de-Peralta Venturina M, Deshpande A, Menon M. Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: an experience of 405 cases. Am J Surg Pathol. 2002;26(3):281–91.CrossRefPubMedGoogle Scholar
  23. 23.
    Tokuda N, Naito S, Matsuzaki O, Nagashima Y, Ozono S, Igarashi T. Collecting duct (Bellini duct) renal cell carcinoma: a nationwide survey in Japan. J Urol. 2006;176(1):40–3; discussion 43.CrossRefPubMedGoogle Scholar
  24. 24.
    Avery RA, Harris JE, Davis CJ Jr, Borgaonkar DS, Byrd JC, Weiss RB. Renal medullary carcinoma: clinical and therapeutic aspects of a newly described tumor. Cancer. 1996;78(1):128–32.CrossRefPubMedGoogle Scholar
  25. 25.
    Cheville JC, Lohse CM, Zincke H, Weaver AL, Leibovich BC, Frank I, Blute ML. Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome. Am J Surg Pathol. 2004;28(4):435–41.CrossRefPubMedGoogle Scholar
  26. 26.
    Lidgren A, Hedberg Y, Grankvist K, Rasmuson T, Bergh A, Ljungberg B. Hypoxia-inducible factor 1alpha expression in renal cell carcinoma analyzed by tissue microarray. Eur Urol. 2006;50(6):1272–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Klatte T, Seligson DB, Riggs SB, Leppert JT, Berkman MK, Kleid MD, Yu H, Kabbinavar FF, Pantuck AJ, Belldegrun AS. Hypoxia-inducible factor 1 alpha in clear cell renal cell carcinoma. Clin Cancer Res. 2007;13(24):7388–93.CrossRefPubMedGoogle Scholar
  28. 28.
    Bui MH, Seligson D, Han KR, Pantuck AJ, Dorey FJ, Huang Y, Horvath S, Leibovich BC, Chopra S, Liao SY, Stanbridge E, Lerman MI, Palotie A, Figlin RA, Belldegrun AS. Carbonic anhydrase IX is an independent predictor of survival in advanced renal clear cell carcinoma: implications for prognosis and therapy. Clin Cancer Res. 2003;9(2):802–11.Google Scholar
  29. 29.
    Sandlund J, Oosterwijk E, Grankvist K, Oosterwijk-Wakka J, Ljungberg B, Rasmuson T. Prognostic impact of carbonic anhydrase IX expression in human renal cell carcinoma. BJU Int. 2007;100(3):556–60.CrossRefPubMedGoogle Scholar
  30. 30.
    Leibovich BC, Sheinin Y, Lohse CM, Thompson RH, Cheville JC, Zavada J, Kwon ED. Carbonic anhydrase IX is not an independent predictor of outcome for patients with clear cell renal cell carcinoma. J Clin Oncol. 2007;25(30):4757–64.CrossRefPubMedGoogle Scholar
  31. 31.
    Kim HL, Seligson D, Liu X, Janzen N, Bui MH, Yu H, Shi T, Belldegrun AS, Horvath S, Figlin RA. Using tumor markers to predict the survival of patients with metastatic renal cell carcinoma. J Urol. 2005;173(5):1496–501.CrossRefPubMedGoogle Scholar
  32. 32.
    Morgan T, Mehra R, Tiemeny P, Wolf J, Wu S, Sangale Z, Brawer M, Stone S, Wu C, Feldman A. A multigene signature based on cell cycle proliferation improves prediction of mortality within 5 years of radical nephrectomy for renal cell carcinoma. Eur Urol. 2018;73(5):763–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Rees CE, Bath PA. The information needs and source preferences of women with breast cancer and their family members: a review of the literature published between 1988 and 1998. J Adv Nurs. 2000;31(4):833–41.CrossRefPubMedGoogle Scholar
  34. 34.
    Jenkins V, Fallowfield L, Saul J. Information needs of patients with cancer: results from a large study in UK cancer centres. Br J Cancer. 2001;84(1):48–51.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Butow PN, Dunn SM, Tattersall MH, Jones QJ. Computer-based interaction analysis of the cancer consultation. Br J Cancer. 1995;71(5):1115–21.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Finelli A, Ismaila N, Bro B, et al. Management of small renal masses: American Society of Clinical Oncology Clinical Practice Guideline JCO2016699645. J Clin Oncol. 2017;35:6.CrossRefGoogle Scholar
  37. 37.
    Kutikov A, Fossett LK, Ramchandani P, Tomaszewski JE, Siegelman ES, Banner MP, Van Arsdalen KN, Wein AJ, Malkowicz SB. Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology. 2006;68(4):737–40.CrossRefPubMedGoogle Scholar
  38. 38.
    Snyder ME, Bach A, Kattan MW, Raj GV, Reuter VE, Russo P. Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex. J Urol. 2006;176(6 Pt 1):2391–5; discussion 2395–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Pahernik S, Ziegler S, Roos F, Melchior SW, Thüroff JW. Small renal tumors: correlation of clinical and pathological features with tumor size. J Urol. 2007;178(2):414–7; discussion 416–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Remzi M, Ozsoy M, Klingler HC, Susani M, Waldert M, Seitz C, Schmidbauer J, Marberger M. Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol. 2006;176(3):896–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Pierorazio PM, Johnson MH, Ball MW, Gorin MA, Trock BJ, Chang P, Wagner AA, McKiernan JM, Allaf ME. Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry. Eur Urol. 2015;68(3):408–15.CrossRefPubMedGoogle Scholar
  42. 42.
    Marzouk K, Tin A, Liu N, Sjoberg D, Hakimi AA, Russo P, Coleman J. The natural history of large renal masses followed on observation. Urol Oncol. 2018;36(8):362.e17–21.CrossRefGoogle Scholar
  43. 43.
    Pierorazio PM, Patel HD, Johnson MH, Sozio SM, Sharma R, Iyoha E, Bass EB, Allaf ME. Distinguishing malignant and benign renal masses with composite models and nomograms: a systematic review and meta-analysis of clinically localized renal masses suspicious for malignancy. Cancer. 2016;122(21):3267–76.CrossRefPubMedGoogle Scholar
  44. 44.
    Kutikov A, Egleston BL, Wong YN, et al. Evaluating overall survival and competing risks of death in patients with localized renal cell carcinoma using a comprehensive nomogram. J Clin Oncol. 2010;28:311.CrossRefPubMedGoogle Scholar
  45. 45.
    Kutikov A, Egleston BL, Canter D, et al. Competing risks of death in patients with localized renal cell carcinoma: a comorbidity based model. J Urol. 2012;188:2077.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Tan H, Norton E, Ye Z, et al. Long-temr survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA. 2012;307(15):1629–35.CrossRefPubMedGoogle Scholar
  47. 47.
    Wang DC, Plante K, Stewart T, Wang D, Formica M, Daugherty M, Bratslavsky G. Comparison of survival for partial vs. radical nephrectomy in young patients with T1a renal cell carcinoma treated at commission on cancer-accredited facilities and influence of comorbidities on treatment choice. Urol Oncol. 2017;35(11):660.e9–660.e15.CrossRefGoogle Scholar
  48. 48.
    Gorin MA, Ball MW, Pierorazio PM, Tanagho YS, Bhayani SB, Kaouk JH, Rogers CG, Stifelman MD, Khalifeh A, Kumar R, Sivarajan G, Allaf ME. Outcomes and predictors of clinical T1 to pathological T3a tumor up-staging after robotic partial nephrectomy: a multi-institutional analysis. J Urol. 2013;190(5):1907–11.CrossRefPubMedGoogle Scholar
  49. 49.
    Tay MH, Thamboo TP, Wu FM, Zhaojin C, Choo TB, Ramaan L, Tiong HY. High R.E.N.A.L. nephrometry scores are associated with pathologic upstaging of clinical T1 renal-cell carcinomas in radical nephrectomy specimens: implications for nephron-sparing surgery. J Endourol. 2014;28(9):1138–42.CrossRefPubMedGoogle Scholar
  50. 50.
    Ramaswamy K, Kheterpal E, Pham H, Mohan S, Stifelman M, Taneja S, Huang WC. Significance of pathologic T3a upstaging in clinical T1 renal masses undergoing nephrectomy. Clin Genitourin Cancer. 2015;13(4):344–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Speed JM, Trinh QD, Choueiri TK, Sun M. Recurrence in localized renal cell carcinoma: a systematic review of contemporary data. Curr Urol Rep. 2017;18(2):15.CrossRefPubMedGoogle Scholar
  52. 52.
    Sorbellini M, Kattan MW, Snyder ME, Reuter V, Motzer R, Goetzl M, McKiernan J, Russo P. A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma. J Urol. 2005;173(1):48–51.CrossRefPubMedGoogle Scholar
  53. 53.
    Lee BH, Feifer A, Feuerstein MA, Benfante NE, Kou L, Yu C, Kattan MW, Russo P. Validation of a postoperative nomogram predicting recurrence in patients with conventional clear cell renal cell carcinoma. Eur Urol Focus. 2018;4(1):100–5.CrossRefPubMedGoogle Scholar
  54. 54.
    Zisman A, Pantuck AJ, Wieder J, Chao DH, Dorey F, Said JW, deKernion JB, Figlin RA, Belldegrun AS. Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. J Clin Oncol. 2002;20(23):4559–66.CrossRefPubMedGoogle Scholar
  55. 55.
    Patard JJ, Kim HL, Lam JS, Dorey FJ, Pantuck AJ, Zisman A, Ficarra V, Han KR, Cindolo L, De La Taille A, Tostain J, Artibani W, Dinney CP, Wood CG, Swanson DA, Abbou CC, Lobel B, Mulders PF, Chopin DK, Figlin RA, Belldegrun AS. Use of the University of California Los Angeles integrated staging system to predict survival in renal cell carcinoma: an international multicenter study. J Clin Oncol. 2004;22(16):3316–22.CrossRefGoogle Scholar
  56. 56.
    Cindolo L, Patard JJ, Chiodini P, Schips L, Ficarra V, Tostain J, de La Taille A, Altieri V, Lobel B, Zigeuner RE, Artibani W, Guillé F, Abbou CC, Salzano L, Gallo C. Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy: a multicenter European study. Cancer. 2005;104(7):1362–71.CrossRefPubMedGoogle Scholar
  57. 57.
    Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score. J Urol. 2002;168(6):2395–400.CrossRefPubMedGoogle Scholar
  58. 58.
    Ficarra V, Martignoni G, Lohse C, Novara G, Pea M, Cavalleri S, Artibani W. External validation of the Mayo Clinic stage, size, grade and necrosis (SSIGN) score to predict cancer specific survival using a European series of conventional renal cell carcinoma. J Urol. 2006;175(4):1235–9.CrossRefPubMedGoogle Scholar
  59. 59.
    Fujii Y, Saito K, Iimura Y, Sakai Y, Koga F, Kawakami S, Kumagai J, Kihara K. External validation of the Mayo Clinic cancer specific survival score in a Japanese series of clear cell renal cell carcinoma. J Urol. 2008;180(4):1290–5; discussion 1295–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Zigeuner R, Hutterer G, Chromecki T, Imamovic A, Kampel-Kettner K, Rehak P, Langner C, Pummer K. External validation of the Mayo Clinic stage, size, grade, and necrosis (SSIGN) score for clear-cell renal cell carcinoma in a single European Centre applying routine pathology. Eur Urol. 2010;57(1):102–9.CrossRefPubMedGoogle Scholar
  61. 61.
    Ficarra V, Novara G, Galfano A, Brunelli M, Cavalleri S, Martignoni G, Artibani W. The “Stage, Size, Grade and Necrosis” score is more accurate than the University of California Los Angeles Integrated Staging System for predicting cancer-specific survival in patients with clear cell renal cell carcinoma. BJU Int. 2009;103(2):165–70.CrossRefGoogle Scholar
  62. 62.
    Parker WP, Cheville JC, Frank I, Zaid HB, Lohse CM, Boorjian SA, Leibovich BC, Thompson RH. Application of the stage, size, grade, and necrosis (SSIGN) score for clear cell renal cell carcinoma in contemporary patients. Eur Urol. 2017;71(4):665–73.CrossRefPubMedGoogle Scholar
  63. 63.
    Karakiewicz PI, Briganti A, Chun FK, Trinh QD, Perrotte P, Ficarra V, Cindolo L, De la Taille A, Tostain J, Mulders PF, Salomon L, Zigeuner R, Prayer-Galetti T, Chautard D, Valeri A, Lechevallier E, Descotes JL, Lang H, Mejean A, Patard JJ. Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol. 2007;25(11):1316–22.CrossRefPubMedGoogle Scholar
  64. 64.
    Zastrow S, Brookman-May S, Cong TA, Jurk S, von Bar I, Novotny V, Wirth M. Decision curve analysis and external validation of the postoperative Karakiewicz nomogram for renal cell carcinoma based on a large single-center study cohort. World J Urol. 2015;33(3):381–8.CrossRefPubMedGoogle Scholar
  65. 65.
    Tan MH, Li H, Choong CV, Chia KS, Toh CK, Tang T, Tan PH, Wong CF, Lau W, Cheng C. The Karakiewicz nomogram is the most useful clinical predictor for survival outcomes in patients with localized renal cell carcinoma. Cancer. 2011;117(23):5314–24.CrossRefPubMedGoogle Scholar
  66. 66.
    Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol. 1999;17(8):2530–40.CrossRefGoogle Scholar
  67. 67.
    Motzer RJ, Bacik J, Murphy BA, Russo P, Mazumdar M. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol. 2002;20(1):289–96.CrossRefGoogle Scholar
  68. 68.
    Motzer RJ, Bacik J, Schwartz LH, Reuter V, Russo P, Marion S, Mazumdar M. Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma. J Clin Oncol. 2004;22(3):454–63.CrossRefGoogle Scholar
  69. 69.
    Patil S, Figlin RA, Hutson TE, Michaelson MD, Négrier S, Kim ST, Huang X, Motzer RJ. Prognostic factors for progression-free and overall survival with sunitinib targeted therapy and with cytokine as first-line therapy in patients with metastatic renal cell carcinoma. Ann Oncol. 2011;22(2):295–300.CrossRefPubMedGoogle Scholar
  70. 70.
    Mekhail TM, Abou-Jawde RM, Boumerhi G, Malhi S, Wood L, Elson P, Bukowski R. Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma. J Clin Oncol. 2005;23(4):832–41.CrossRefGoogle Scholar
  71. 71.
    Motzer RJ, Bukowski RM, Figlin RA, Hutson TE, Michaelson MD, Kim ST, Baum CM, Kattan MW. Prognostic nomogram for sunitinib in patients with metastatic renal cell carcinoma. Cancer. 2008;113(7):1552–8.CrossRefPubMedGoogle Scholar
  72. 72.
    Karakiewicz PI, Sun M, Bellmunt J, Sneller V, Escudier B. Prediction of progression-free survival rates after bevacizumab plus interferon versus interferon alone in patients with metastatic renal cell carcinoma: comparison of a nomogram to the Motzer criteria. Eur Urol. 2011;60(1):48–56.CrossRefPubMedGoogle Scholar
  73. 73.
    Margulis V, Shariat SF, Rapoport Y, Rink M, Sjoberg DD, Tannir NM, Abel EJ, Culp SH, Tamboli P, Wood CG. Development of accurate models for individualized prediction of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma. Eur Urol. 2013;63(5):947–52.CrossRefPubMedGoogle Scholar
  74. 74.
    Manley BJ, Tennenbaum DM, Vertosick EA, Hsieh JJ, Sjoberg DD, Assel M, Benfante NE, Strope SA, Kim E, Casuscelli J, Becerra MF, Coleman JA, Hakimi AA, Russo P. The difficulty in selecting patients for cytoreductive nephrectomy: an evaluation of previously described predictive models. Urol Oncol. 2017;35(1):35.e1–5.CrossRefGoogle Scholar
  75. 75.
    Kutikov A, Smaldone MC, Egleston BL, Manley BJ, Canter DJ, Simhan J, Boorjian SA, Viterbo R, Chen DY, Greenberg RE, Uzzo RG. Anatomic features of enhancing renal masses predict malignant and high-grade pathology: a preoperative nomogram using the RENAL nephrometry score. Eur Urol. 2011;60(2):241–8.CrossRefPubMedPubMedCentralGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of UrologyLahey Hospital and Medical CenterBurlingtonUSA
  2. 2.Department of Quantitative Health SciencesCleveland ClinicClevelandUSA

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