EURURO Vol. 71 No. 4

672 692

perioperative care, and treatment options over time.
However, all patients in this study had uniform pathologic
review of their specimens, and we demonstrate utility of the
SSIGN score in the subset of contemporary patients managed
with both RN and PN. Further, to our knowledge, this work
represents the largest single experience and longest follow-
up of patients evaluated with the SSIGN score.
5. Conclusions
We found that the SSIGN score, as originally described and
using the original patients, retains its predictive accuracy
with longer follow-up and incorporating the competing risk
of non-RCC death. We also noted among contemporarily
managed patients, both with RN and PN, that the SSIGN
score is a valuable prognostic tool for ccRCC. Finally, we
observed improvements in survival for ccRCC patient over
time, even after controlling for the SSIGN score. These
findings support continued utilization of the SSIGN score
and serve to guide patient counseling following surgical
management of ccRCC.
Author contributions: R. Houston Thompson had full access to all the
data in the study and takes responsibility for the integrity of the data and
the accuracy of the data analysis.
Study concept and design: Parker, Frank, Lohse, Thompson.
Acquisition of data: Lohse.
Analysis and interpretation of data: Parker, Lohse, Thompson.
Drafting of the manuscript: Parker, Lohse, Thompson.
Critical revision of the manuscript for important intellectual content: Parker,
Cheville, Frank, Zaid, Lohse, Boorjian, Leibovich, Thompson.
Statistical analysis: Lohse.
Obtaining funding: None.
Administrative, technical, or material support: None.
Supervision: Thompson.
Other: None.
Financial disclosures: R. Houston Thompson certifies that all conflicts of
interest, including specific financial interests and relationships and
affiliations relevant to the subject matter or materials discussed in the
manuscript (eg, employment/affiliation, grants or funding, consultan-
cies, honoraria, stock ownership or options, expert testimony, royalties,
or patents filed, received, or pending), are the following: None.
Funding/Support and role of the sponsor: This publication was made
possible in part by the Clinical and Translational Science Awards Grant
UL1 TR000135 from the National Center for Advancing Translational
Sciences, a component of the National Institutes of Health (NIH). Its
contents are solely the responsibility of the authors and do not
necessarily represent the official views of the NIH.
Appendix A. Supplementary data
Supplementary data associated with this article can be
found, in the online version, at
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