Carbonic anhydrase-IX score is a novel biomarker that predicts recurrence and survival for high-risk, nonmetastatic renal cell carcinoma: Data from the phase III ARISER clinical trial

• Published in: Urologic oncology 2015-05, Vol.33 (5), p.204.e25-204.e33
• Main Authors: Chamie, Karim, MD, MSHS, Klöpfer, Pia, MD, Bevan, Paul, PhD, Störkel, Stephan, MD, Said, Jonathan, MD, Fall, Barbara, MD, Belldegrun, Arie S., MD, Pantuck, Allan J., MD, MS
• Format: Article
• Language: English
• Subjects: Adjuvant therapy; Biomarkers, Tumor - analysis; Biomarkers, Tumor - metabolism; CAIX; Carbonic Anhydrases - biosynthesis; Carbonic Anhydrases - metabolism; Carcinoma, Renal Cell - genetics; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - pathology; Clinical trial; Disease-Free Survival; Double-Blind Method; Humans; Male; Neoplasm Recurrence, Local; Prognosis; Prognostic biomarker; Prospective Studies; Renal cell carcinoma; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2015.02.013

Abstract Introduction and objective With a limited number of prognostic and predictive biomarkers available, carbonic anhydrase-IX (CAIX) has served as an important prognostic biomarker for patients with clear cell renal cell carcinoma (ccRCC). However, studies have recently called into question the role of CAIX as a biomarker for ccRCC. To investigate this uncertainty, we quantified the association of CAIX with lymphatic involvement and survival using data from ARISER study (WX-2007-03-HR)—a prospective trial involving subjects with high-risk nonmetastatic ccRCC. Methods and materials We reviewed the records of 813 patients enrolled in the ARISER study. Central review of histology, grade, and CAIX staining (frequency and intensity) was performed. CAIX score was derived by multiplying the staining intensity (1–3) by percent positive cells (0%–100%), yielding a range of 0 to 300. We quantified the association of CAIX expression and score with lymphatic spread and survival (disease-free survival [DFS] and overall survival [OS]) using Kaplan-Meier and multivariable propensity score adjusted Cox regression analyses. Results Median follow-up of the cohort was 54.2 months. Although 56% of subjects with lymphatic involvement had CAIX>85%, only 33% had CAIX score≥200. On multivariable analysis, CAIX>85% was not a statistically significant predictor of DFS and OS ( P = 0.06 and P = 0.15, respectively). However, CAIX score≥200, when compared with CAIX score≤100, was associated with improved DFS and OS ( P = 0.01 and P = 0.01, respectively) on multivariable analysis. Conclusions The largest, multicenter, prospective analysis of patients with high-risk nonmetastatic ccRCC demonstrates the utility of CAIX score as a statistically significant prognostic biomarker for survival. We recommend that CAIX score be quantified for all patients with high-risk disease after nephrectomy.