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UCLA Integrated Staging System (UISS) for Renal Cell Carcinoma (RCC)

UCLA Integrated Staging System (UISS) for Renal Cell Carcinoma (RCC)
Disease extent
Primary tumor stage (pT) — used only if localized
Fuhrman nuclear grade
ECOG performance status
ResultUISS group I

Projected overall survival about 96 % at 2 years and 94 % at 5 years.

UISS group
I
2-year survival
96 %
5-year survival
94 %

When to use

  • Prognostication and counselling for patients with renal cell carcinoma across the full spectrum from localized to metastatic disease.
  • Stratifying patients for clinical trial entry using a single integrated staging system rather than TNM stage alone.

Formula

Combines 1997 TNM stage, Fuhrman grade, and ECOG performance status into 5 groups: Localized T1/grade 1-2/ECOG 0 = I; localized T1 with grade 3-4 or ECOG>=1, or T2/ECOG 0 = II (also T3-4 with grade 1 and ECOG 0); T2/ECOG>=1 or T3-4 (grade>=2 or ECOG>=1), or node-positive/ECOG 0 = III; node-positive/ECOG>=1 or metastatic/ECOG 0 = IV; metastatic/ECOG>=1 = V.

Pearls and pitfalls

  • Developed in a single-institution nephrectomy cohort (1989-1999); the 1997 TNM system it was built on has since been revised, so mapping to current TNM requires care.
  • Superior to TNM stage alone for discriminating survival, but has been compared less favourably with more recent, non-metastatic-specific models (e.g. SSIGN, Leibovich) in some validations.

References

  1. Zisman A, Pantuck AJ, Dorey F, et al. Improved prognostication of renal cell carcinoma using an integrated staging system. J Clin Oncol. 2001;19(6):1649-1657.