Snail predicts recurrence and survival of patients with localized clear cell renal cell carcinoma after surgical resection

Background: Snail (known as SNAII). a zinc-finger transcription factor, is best known for the induction of epithelial-to-mesenchymal transition, which has emerged as a recognized mechanism underlying epithelial cancer progression. Herein, the aim is to determine the effect of Snail expression on recurrence and survival of patients with localized clear cell renal cell carcinoma (ccRCC) following surgery. Methods: We retrospectively enrolled 255 patients (188 in group A and 67 in group B) with localized ccRCC undergoing nephrectomy at a single center. Prognostic value and clinical outcomes were evaluated. Results: In both groups, cytoplasmic Snail intensity correlates positively with Fuhrman grade. High nuclear but not cytoplasmic Snail intensity indicates early recurrence and poor survival of patients with localized ccRCC. Moreover, high nuclear Snail intensity predicts unfavorable survival of patients with T2-4 stage cancer and early recurrence of all stage patients. Nuclear Snail intensity was identified as an independent adverse prognostic factor for recurrence and survival. The predictive accuracy of University of Los Angeles Integrated Staging System and the Mayo Clinic Stage, Size, Grade, and Necrosis prognostic models was improved when nuclear Snail expression was added. Conclusion: Nuclear Snail expression is a potential independent adverse prognostic biomarker for recurrence and survival of patients with localized ccRCC after nephrectomy. (C) 2014 Elsevier Inc. All rights reserved.