To investigate the predictive value of SSIGN grading combined with gamma-glutamyl transpeptidase (GGT) in postoperative recurrence of high-risk non-metastatic renal carcinoma.

Data of 80 patients with high-risk non-metastatic renal cancer admitted to the Central Hospital Affiliated to Chongqing University of Technology from January 2020 to January 2022 were retrospectively analyzed. All patients underwent SSIGN grading before surgery, serum GGT level was detected, and postoperative regular outpatient visit and telephone follow-up were conducted to analyze postoperative tumor recurrence. Kaplan-Meier survival analysis was conducted for relapse-free survival of high-risk non-metastatic renal cancer patients with different SSIGN grades and GGT levels. Univariate and multivariate Cox regression analysis was conducted for factors influencing postoperative recurrence of high-risk non-metastatic renal cancer patients. Receiver operating characteristic (ROC) curve analysis of the value of SSIGN grading combined with GGT in predicting postoperative recurrence in high-risk non-metastatic renal cancer patients.

The median follow-up was 19(12-36) months. During the follow-up, 18 cases relapsed, with a recurrence rate of 22.50%. pT₂, tumor diameter ≥5 cm, Fuhrman nuclear grade 3-4, lymphovascular infiltration, tumor necrosis ratio and serum GGT level in the recurrence group were higher than those in the non-recurrence group (P<0.05), and the difference in SSIGN grade between the two groups was statistically significant (P<0.05). The relapse-free survival rate of different SSIGN grades was statistically significant (P<0.05), and the relapse-free survival rate of high GGT group was lower than that of low GGT group (P<0.05). Multivariate Cox regression results showed that high risk of pT₂ and SSIGN grading and high GGT were risk factors for postoperative recurrence in high-risk non-metastatic renal cancer patients (P<0.05). The area under the curve predicted by SSIGN grade and GGT for postoperative recurrence of high-risk non-metastatic renal cancer was 0.847 and 0.705, respectively, and the area under the curve predicted by combined SSIGN grade with GGT was 0.955, which was higher than that predicted by alone (P<0.05).

High SSIGN risk ratio and serum GGT level before operation are associated with low relapse-free survival rate in high-risk non-metastatic renal cancer patients with postoperative recurrence. Combined SSIGN grade and GGT can help to predict the risk of postoperative recurrence of high-risk non-metastatic renal cancer.