serum amyloid a protein


Summary: An ACUTE PHASE REACTION protein present in low concentrations in normal sera, but found at higher concentrations in sera of older persons and in patients with AMYLOIDOSIS. It is the circulating precusor of amyloid A protein, which is found deposited in AA type AMYLOID FIBRILS.

Top Publications

  1. Lee H, Kim S, Baek S, Choi J, Cho K, Zabel B, et al. Serum amyloid A stimulates macrophage foam cell formation via lectin-like oxidized low-density lipoprotein receptor 1 upregulation. Biochem Biophys Res Commun. 2013;433:18-23 pubmed publisher
    ..Our findings therefore suggest that SAA stimulates foam cell formation via LOX1 induction, and thus likely contributes to atherogenesis. ..
  2. Jabaut J, Ather J, Taracanova A, Poynter M, Ckless K. Mitochondria-targeted drugs enhance Nlrp3 inflammasome-dependent IL-1? secretion in association with alterations in cellular redox and energy status. Free Radic Biol Med. 2013;60:233-45 pubmed publisher
  3. Millucci L, Spreafico A, Tinti L, Braconi D, Ghezzi L, Paccagnini E, et al. Alkaptonuria is a novel human secondary amyloidogenic disease. Biochim Biophys Acta. 2012;1822:1682-91 pubmed publisher
    ..Our findings on alkaptonuria as a novel type II AA amyloidosis open new important perspectives for its therapy, since methotrexate treatment proved to significantly reduce in vitro HGA-induced A-amyloid aggregates...
  4. Chiba T, Chang M, Wang S, Wight T, McMillen T, Oram J, et al. Serum amyloid A facilitates the binding of high-density lipoprotein from mice injected with lipopolysaccharide to vascular proteoglycans. Arterioscler Thromb Vasc Biol. 2011;31:1326-32 pubmed publisher
    ..SAA enrichment of HDL under inflammatory conditions plays an important role in the binding of HDL to vascular proteoglycans. ..
  5. Witting P, Song C, Hsu K, Hua S, Parry S, Aran R, et al. The acute-phase protein serum amyloid A induces endothelial dysfunction that is inhibited by high-density lipoprotein. Free Radic Biol Med. 2011;51:1390-8 pubmed publisher
    ..The relative HDL to SAA concentrations may regulate the proatherogenic properties of SAA on the vascular endothelium. ..
  6. Zhang L, Yuan B, Li H, Tao S, Yan H, Chang L, et al. Associations of genetic polymorphisms of SAA1 with cerebral infarction. Lipids Health Dis. 2013;12:130 pubmed publisher
    b>Serum amyloid A protein (SAA) is both an inflammatory factor and an apolipoprotein. However, the relation between genetic polymorphisms of SAA and cerebral infarction (CI) remains unclear...
  7. Simons J, Al Shawi R, Ellmerich S, Speck I, Aslam S, Hutchinson W, et al. Pathogenetic mechanisms of amyloid A amyloidosis. Proc Natl Acad Sci U S A. 2013;110:16115-20 pubmed publisher
  8. Li B, Dong Z, Liu H, Xia Y, Liu X, Luo B, et al. Serum amyloid A stimulates lipoprotein-associated phospholipase A2 expression in vitro and in vivo. Atherosclerosis. 2013;228:370-9 pubmed publisher
    ..Furthermore, the results suggested the activation of PPAR-? played a crucial role in this process. These results demonstrate that SAA up-regulates Lp-PLA2 production significantly via a FPRL1/MAPKs./PPAR-? signaling pathway. ..
  9. Christensen M, Jacobsen S, Ichiyanagi T, Kjelgaard Hansen M. Evaluation of an automated assay based on monoclonal anti-human serum amyloid A (SAA) antibodies for measurement of canine, feline, and equine SAA. Vet J. 2012;194:332-7 pubmed publisher
    ..The monoclonal nature of the antibodies suggests strong, long-term inter-batch performance stability...

More Information


  1. Bozinovski S, Uddin M, Vlahos R, Thompson M, McQualter J, Merritt A, et al. Serum amyloid A opposes lipoxin A? to mediate glucocorticoid refractory lung inflammation in chronic obstructive pulmonary disease. Proc Natl Acad Sci U S A. 2012;109:935-40 pubmed publisher
    ..Taken together, these findings identify SAA as a therapeutic target for inhibition and implicate SAA as a mediator of GC-resistant lung inflammation that can overwhelm organ protective signaling by lipoxins at ALX/FPR2 receptors. ..
  2. Ather J, Ckless K, Martin R, Foley K, Suratt B, Boyson J, et al. Serum amyloid A activates the NLRP3 inflammasome and promotes Th17 allergic asthma in mice. J Immunol. 2011;187:64-73 pubmed publisher
  3. Navab M, Reddy S, Anantharamaiah G, Imaizumi S, Hough G, Hama S, et al. Intestine may be a major site of action for the apoA-I mimetic peptide 4F whether administered subcutaneously or orally. J Lipid Res. 2011;52:1200-10 pubmed publisher
    ..We conclude: i) the dose of 4F administered and not the plasma level achieved determines efficacy; ii) the intestine may be a major site of action for the peptide regardless of the route of administration. ..
  4. Soler L, Luyten T, Stinckens A, Buys N, Ceron J, Niewold T. Serum amyloid A3 (SAA3), not SAA1 appears to be the major acute phase SAA isoform in the pig. Vet Immunol Immunopathol. 2011;141:109-15 pubmed publisher
    ..Finally, it is concluded that the pig is unique among other species in that the main circulating hepatic SAA isotype shows the characteristics of local highly alkaline SAA. This likely precludes a function as apolipoprotein. ..
  5. Casella S, Fazio F, Giannetto C, Giudice E, Piccione G. Influence of transportation on serum concentrations of acute phase proteins in horse. Res Vet Sci. 2012;93:914-7 pubmed publisher
    ..05) on Hp, SAA and WBCs. These modifications appeared to be innovative showing that equine Hp, generally considered as moderate acute phase protein, increases more rapidly than the SAA after transportation-induced stress. ..
  6. Soler L, Molenaar A, Merola N, Eckersall P, Gutierrez A, Ceron J, et al. Why working with porcine circulating serum amyloid A is a pig of a job. J Theor Biol. 2013;317:119-25 pubmed publisher
    ..It is concluded that pig systemic SAA is unique compared to other species, which raises questions about the proposed importance of acute phase SAA in HDL metabolism during inflammation in this species. ..
  7. King V, Thompson J, Tannock L. Serum amyloid A in atherosclerosis. Curr Opin Lipidol. 2011;22:302-7 pubmed publisher
    ..This review will discuss recent experimental evidence supporting a causal role of SAA with atherosclerosis. ..
  8. Xu Z, Chen Y, Huang A, Varghese Z, Moorhead J, Yan F, et al. Inflammatory stress exacerbates lipid-mediated renal injury in ApoE/CD36/SRA triple knockout mice. Am J Physiol Renal Physiol. 2011;301:F713-22 pubmed publisher
    ..Low blood cholesterol levels, resulting from inflammation, may be associated with high risk for chronic renal fibrosis. ..
  9. Chan T, Gu F. Early diagnosis of sepsis using serum biomarkers. Expert Rev Mol Diagn. 2011;11:487-96 pubmed publisher
    ..The ongoing efforts in the development of a multiplex point-of-care testing kit, enabling quick and reliable detection of serum biomarkers, may have great potential for early diagnosis of sepsis. ..
  10. Wroblewski J, Jahangiri A, Ji A, de Beer F, van der Westhuyzen D, Webb N. Nascent HDL formation by hepatocytes is reduced by the concerted action of serum amyloid A and endothelial lipase. J Lipid Res. 2011;52:2255-61 pubmed publisher
    ..Our findings suggest that a reduction in nascent HDL formation may be partly responsible for reduced HDL-C during inflammation when both EL and SAA are known to be upregulated. ..
  11. Connolly M, Mullan R, McCormick J, Matthews C, Sullivan O, Kennedy A, et al. Acute-phase serum amyloid A regulates tumor necrosis factor ? and matrix turnover and predicts disease progression in patients with inflammatory arthritis before and after biologic therapy. Arthritis Rheum. 2012;64:1035-45 pubmed publisher
    ..The ability of A-SAA to regulate TNF? suggests that A-SAA signaling pathways may provide new therapeutic strategies for the treatment of inflammatory arthritis. ..
  12. Weichhart T, Kopecky C, Kubicek M, Haidinger M, Döller D, Katholnig K, et al. Serum amyloid A in uremic HDL promotes inflammation. J Am Soc Nephrol. 2012;23:934-47 pubmed publisher
    ..These data suggest a potential link between the high levels of inflammation and cardiovascular mortality in uremia...
  13. Xie X, Ma Y, Yang Y, Fu Z, Li X, Zheng Y, et al. Polymorphisms in the SAA1 gene are associated with ankle-to-brachial index in Han Chinese healthy subjects. Blood Press. 2011;20:232-8 pubmed publisher
    OBJECTIVE. Recent study suggested that the genetic polymorphisms of serum amyloid A protein (SAA) were linked to cardiovascular disease (CVD)...
  14. Jahangiri A, Wilson P, Hou T, Brown A, King V, Tannock L. Serum amyloid A is found on ApoB-containing lipoproteins in obese humans with diabetes. Obesity (Silver Spring). 2013;21:993-6 pubmed publisher
    ..In human subjects, SAA is found in apoB-containing lipoprotein particles only in obese subjects with type 2 diabetes, but not in healthy obese or obese subjects with MetS. ..
  15. Soler L, Gutierrez A, Martinez Subiela S, Ceron J. Development and validation of a novel competitive ELISA for the detection of serum amyloid A in pigs. Vet J. 2011;190:e7-11 pubmed publisher
    ..This novel assay precisely and sensitively measures SAA levels in pigs and will facilitate the more accurate assessment and study of the acute phase response in this species. ..
  16. Kisilevsky R, Manley P. Acute-phase serum amyloid A: perspectives on its physiological and pathological roles. Amyloid. 2012;19:5-14 pubmed publisher
    ..Furthermore, in apoE(-/-) mice, domains near the N- and C- termini of SAA inhibit the initiation and progression of aortic lipid lesions illustrating the conflicting nature of these two sets of data. ..
  17. Xu X, Sun X, Pang L, Huang G, Huang J, Shi M, et al. Rs12218 In SAA1 gene was associated with serum lipid levels. Lipids Health Dis. 2013;12:116 pubmed publisher
    ..01). Our results indicated that the rs12218 in the SAA1gene was associated with lipid levels in a Chinese population. ..
  18. Tamamoto T, Ohno K, Goto Koshino Y, Tsujimoto H. Feline serum amyloid A protein as an endogenous Toll-like receptor 4 agonist. Vet Immunol Immunopathol. 2013;155:190-6 pubmed publisher
    ..These results suggest that feline SAA can play an important role in the regulation of inflammation and immune responses as it does in humans. ..
  19. Jang S, Shin Y, Lee H, Park J, Suh D, Kim J, et al. Local production of serum amyloid a is implicated in the induction of macrophage chemoattractants in Schwann cells during wallerian degeneration of peripheral nerves. Glia. 2012;60:1619-28 pubmed publisher
    ..Our findings suggest that locally produced SAA might play an important role in Wallerian degeneration after peripheral nerve injury. ..
  20. Sung H, Jeon S, Ahn J, Seul K, Kim J, Lee J, et al. Large-scale isotype-specific quantification of Serum amyloid A 1/2 by multiple reaction monitoring in crude sera. J Proteomics. 2012;75:2170-80 pubmed publisher
    ..Finally, successful quantification of SAA2 in crude serum by MRM, for the first time, shows that SAA2 can be a good biomarker for the detection of lung cancers. ..
  21. Nakamura T. Amyloid A amyloidosis secondary to rheumatoid arthritis: pathophysiology and treatments. Clin Exp Rheumatol. 2011;29:850-7 pubmed
    ..These AA amyloid fibrils derive from the circulatory acute-phase reactant serum amyloid A protein (SAA), and may be controlled by treatment...
  22. Tölle M, Huang T, Schuchardt M, Jankowski V, Prüfer N, Jankowski J, et al. High-density lipoprotein loses its anti-inflammatory capacity by accumulation of pro-inflammatory-serum amyloid A. Cardiovasc Res. 2012;94:154-62 pubmed publisher
    ..It is a novel finding that SAA acts as a pro-inflammatory molecule to reduce the anti-inflammatory properties of HDL. ..
  23. Xie X, Ma Y, Yang Y, Li X, Fu Z, Zheng Y, et al. Serum uric acid levels are associated with polymorphism in the SAA1 gene in Chinese subjects. PLoS ONE. 2012;7:e40263 pubmed publisher
    Serum uric acid (SUA) is a cardiovascular risk marker associated with inflammation. The serum amyloid A protein (SAA) is an inflammatory factor and is associated with cardiovascular disease (CVD)...
  24. Liu L, Lin S, Chen C, Chen Y, Tai C, Chang S, et al. Serum amyloid A induces lipolysis by downregulating perilipin through ERK1/2 and PKA signaling pathways. Obesity (Silver Spring). 2011;19:2301-9 pubmed publisher
    ..The finding could lead to developing new strategies for reducing human obesity. ..
  25. Niemi K, Teirilä L, Lappalainen J, Rajamäki K, Baumann M, Öörni K, et al. Serum amyloid A activates the NLRP3 inflammasome via P2X7 receptor and a cathepsin B-sensitive pathway. J Immunol. 2011;186:6119-28 pubmed publisher
    ..Furthermore, the SAA-induced secretion of active cathepsin B may lead to extracellular processing of SAA and, thus, potentially to the development of amyloid A amyloidosis. ..
  26. Kappelle P, Bijzet J, Hazenberg B, Dullaart R. Lower serum paraoxonase-1 activity is related to higher serum amyloid a levels in metabolic syndrome. Arch Med Res. 2011;42:219-25 pubmed publisher
    ..271, p=0.049). Decreased serum PON-1 activity in MetS may in part be attributable to higher SAA levels. We suggest that higher SAA levels contribute to impaired HDL anti-oxidative function in MetS via an effect on PON-1 regulation. ..
  27. Feng Z, Li X, Jiang R, Deng H, Yang M, Zhou Q, et al. Associations of SAA1 gene polymorphism with lipid lelvels and osteoporosis in Chinese women. Lipids Health Dis. 2013;12:39 pubmed publisher
    ..05). The present results indicate that both osteoporosis and lipids levels are associated with the TT genotype of rs12218 in the human SAA1 gene. ..
  28. Holzer M, Birner Gruenberger R, Stojakovic T, El Gamal D, Binder V, Wadsack C, et al. Uremia alters HDL composition and function. J Am Soc Nephrol. 2011;22:1631-41 pubmed publisher
    ..Assessing HDL composition and function in renal disease may help identify patients at increased risk for cardiovascular disease...
  29. van Bussel B, Schouten F, Henry R, Schalkwijk C, de Boer M, Ferreira I, et al. Endothelial dysfunction and low-grade inflammation are associated with greater arterial stiffness over a 6-year period. Hypertension. 2011;58:588-95 pubmed publisher
    ..This provides evidence that arterial stiffening may be a mechanism through which endothelial dysfunction and low-grade inflammation lead to cardiovascular disease. ..
  30. Dong Z, Wu T, Qin W, An C, Wang Z, Zhang M, et al. Serum amyloid A directly accelerates the progression of atherosclerosis in apolipoprotein E-deficient mice. Mol Med. 2011;17:1357-64 pubmed publisher
    ..Thus, an increase in plasma SAA directly accelerates the progression of atherosclerosis in ApoE?/? mice. SAA is not only a risk marker for atherosclerosis but also an active participant in atherogenesis. ..
  31. Lakota K, Resnik N, Mrak Poljsak K, Sodin Semrl S, Veranic P. Colocalization of serum amyloid a with microtubules in human coronary artery endothelial cells. J Biomed Biotechnol. 2011;2011:528276 pubmed publisher
    ..These different locations of SAA in endothelial cells strongly indicate multiple potential functions of this protein. ..
  32. Ishii W, Liepnieks J, Yamada T, Benson M, Kluve Beckerman B. Human SAA1-derived amyloid deposition in cell culture: a consistent model utilizing human peripheral blood mononuclear cells and serum-free medium. Amyloid. 2013;20:61-71 pubmed publisher
    ..Attesting to the reproducibility and general applicability of this model, amyloid formation has been documented in cultures established from eight PBMC donors. ..
  33. van der Hilst J. Recent insights into the pathogenesis of type AA amyloidosis. ScientificWorldJournal. 2011;11:641-50 pubmed publisher
    ..In this review, recent insights into the pathogenesis of amyloidosis are discussed, in addition to a new hypothesis for a role of HSPs in the pathogenesis of type AA. ..
  34. Saber A, Lamson J, Jacobsen N, Ravn Haren G, Hougaard K, Nyendi A, et al. Particle-induced pulmonary acute phase response correlates with neutrophil influx linking inhaled particles and cardiovascular risk. PLoS ONE. 2013;8:e69020 pubmed publisher
    ..Pulmonary acute phase response may constitute a direct link between particle inhalation and risk of cardiovascular disease. We propose that the particle-induced pulmonary acute phase response may predict risk for cardiovascular disease. ..
  35. Poitou C, Divoux A, Faty A, Tordjman J, Hugol D, Aissat A, et al. Role of serum amyloid a in adipocyte-macrophage cross talk and adipocyte cholesterol efflux. J Clin Endocrinol Metab. 2009;94:1810-7 pubmed publisher
    ..3-fold in a dose-dependent manner. This work provides original insight suggesting that A-SAA is a player in the dialogue between hypertrophied adipocytes and macrophages through its regulation of adipocyte cholesterol efflux. ..
  36. Jacobsen S, Kjelgaard Hansen M. Evaluation of a commercially available apparatus for measuring the acute phase protein serum amyloid A in horses. Vet Rec. 2008;163:327-30 pubmed
    ..The assay systematically underestimated the concentrations of SAA in comparison with the results of the validated assay. The assay detected the expected difference in SAA concentrations between the healthy and diseased horses. ..
  37. de Jesus Rodriguez B, Chevaleyre C, Henry G, Molle D, Virlogeux Payant I, Berri M, et al. Identification in milk of a serum amyloid A peptide chemoattractant for B lymphoblasts. BMC Immunol. 2009;10:4 pubmed publisher
    ..These data are consistent with the SAA23-45 fragment being involved in preplasma B-cell recruitment to the mammary gland and resultant benefit to the neonate. ..
  38. Paret C, Schön Z, Szponar A, Kovacs G. Inflammatory protein serum amyloid A1 marks a subset of conventional renal cell carcinomas with fatal outcome. Eur Urol. 2010;57:859-66 pubmed publisher
    ..Limitation of the study is a relatively small number (72) of patients having follow up. SAA1 seems to be a useful marker to estimate the prognosis of conventional RCCs. ..
  39. Malle E, Sodin Semrl S, Kovacevic A. Serum amyloid A: an acute-phase protein involved in tumour pathogenesis. Cell Mol Life Sci. 2009;66:9-26 pubmed publisher
  40. Koutsokera A, Kiropoulos T, Nikoulis D, Daniil Z, Tsolaki V, Tanou K, et al. Clinical, functional and biochemical changes during recovery from COPD exacerbations. Respir Med. 2009;103:919-26 pubmed publisher
    ..Although late-recoverers have lower FEV(1) on admission, none of the measured parameters is able to predict early symptomatic recovery. ..
  41. Gardiner G, O Flaherty S, Casey P, Weber A, McDonald T, Cronin M, et al. Evaluation of colostrum-derived human mammary-associated serum amyloid A3 (M-SAA3) protein and peptide derivatives for the prevention of enteric infection: in vitro and in murine models of intestinal disease. FEMS Immunol Med Microbiol. 2009;55:404-13 pubmed publisher
    ..Overall, although promising anti-infective activity was demonstrated in vitro, neither the 42-mer M-SAA3 protein nor a 10-mer peptide derivative prevented enteric infection in the animal models tested. ..
  42. de Seny D, Fillet M, Ribbens C, Maree R, Meuwis M, Lutteri L, et al. Monomeric calgranulins measured by SELDI-TOF mass spectrometry and calprotectin measured by ELISA as biomarkers in arthritis. Clin Chem. 2008;54:1066-75 pubmed publisher
    ..The fact that the SELDI-TOF MS data were correlated with results obtained with the classic calprotectin ELISA test supports the reliability of this new proteomic technique. ..
  43. Findeisen P, Zapatka M, Peccerella T, Matzk H, Neumaier M, Schadendorf D, et al. Serum amyloid A as a prognostic marker in melanoma identified by proteomic profiling. J Clin Oncol. 2009;27:2199-208 pubmed publisher
    ..SAA combined with CRP might be used as prognostic serological biomarkers in early-stage melanoma patients, helping to discriminate low-risk patients from high-risk patients needing adjuvant treatment. ..
  44. Westermark G, Westermark P. Serum amyloid A and protein AA: molecular mechanisms of a transmissible amyloidosis. FEBS Lett. 2009;583:2685-90 pubmed publisher
    ..In mice, development of AA-amyloidosis can also be accelerated by other components with amyloid-like properties. A new possible risk factor may appear with synthetically made fibrils from short peptides, constructed for tissue repair. ..
  45. Jylhävä J, Haarala A, Eklund C, Pertovaara M, Kahonen M, Hutri Kähönen N, et al. Serum amyloid A is independently associated with metabolic risk factors but not with early atherosclerosis: the Cardiovascular Risk in Young Finns Study. J Intern Med. 2009;266:286-95 pubmed publisher
    ..Further longitudinal studies will show whether SAA holds a prognostic value as a risk marker, analogously to CRP. ..
  46. Hatanaka E, Dermargos A, Armelin H, Curi R, Campa A. Serum amyloid A induces reactive oxygen species (ROS) production and proliferation of fibroblast. Clin Exp Immunol. 2011;163:362-7 pubmed publisher
    ..These findings support the notion that, in chronic inflammatory sites, SAA activated fibroblast proliferation and ROS production. ..
  47. Xie X, Ma Y, Yang Y, Fu Z, Li X, Huang D, et al. Polymorphisms in the SAA1/2 gene are associated with carotid intima media thickness in healthy Han Chinese subjects: the Cardiovascular Risk Survey. PLoS ONE. 2010;5:e13997 pubmed publisher
    b>Serum amyloid A protein (SAA) is not only an inflammatory factor, but also an apolipoprotein that can replace apolipoprotein A1 (apoA1) as the major apolipoprotein of high-density lipoprotein (HDL), which has been linked to ..
  48. Xie X, Ma Y, Yang Y, Fu Z, Li X, Ma X, et al. [Association of genetic polymorphisms of serum amyloid protein A1 with plasma high density lipoproteins cholesterol]. Zhonghua Yi Xue Za Zhi. 2010;90:1824-6 pubmed
    ..27 ± 0.07) mmol/L vs (1.41 ± 0.03) mmol/L, P = 0.048]. In Chinese Han people, the genetic polymorphism of SAA1 may reflect the serum concentration of HDL-C. The carriers with CC genotype have a lower HDL-C level. ..
  49. Kramer H, Lavender K, Qin L, Stacey A, Liu M, Di Gleria K, et al. Elevation of intact and proteolytic fragments of acute phase proteins constitutes the earliest systemic antiviral response in HIV-1 infection. PLoS Pathog. 2010;6:e1000893 pubmed publisher
    ..Insights gained into the mechanism of action of acute-phase reactants and other innate molecules against HIV and how they are induced could be exploited for the future development of more efficient prophylactic vaccine strategies. ..
  50. Cetinkaya M, Ozkan H, Koksal N, Celebi S, Hacimustafaoglu M. Comparison of serum amyloid A concentrations with those of C-reactive protein and procalcitonin in diagnosis and follow-up of neonatal sepsis in premature infants. J Perinatol. 2009;29:225-31 pubmed publisher
  51. Wilson P, Thompson J, Webb N, de Beer F, King V, Tannock L. Serum amyloid A, but not C-reactive protein, stimulates vascular proteoglycan synthesis in a pro-atherogenic manner. Am J Pathol. 2008;173:1902-10 pubmed publisher
    ..Thus, SAA alters vascular proteoglycans in a pro-atherogenic manner via the stimulation of TGF-beta and may play a causal role in the development of atherosclerosis. ..
  52. Wang X, Chai H, Wang Z, Lin P, Yao Q, Chen C. Serum amyloid A induces endothelial dysfunction in porcine coronary arteries and human coronary artery endothelial cells. Am J Physiol Heart Circ Physiol. 2008;295:H2399-408 pubmed publisher
    ..These findings suggest that SAA may contribute to the progress of coronary artery disease. ..
  53. Vermaat J, van der Tweel I, Mehra N, Sleijfer S, Haanen J, Roodhart J, et al. Two-protein signature of novel serological markers apolipoprotein-A2 and serum amyloid alpha predicts prognosis in patients with metastatic renal cell cancer and improves the currently used prognostic survival models. Ann Oncol. 2010;21:1472-81 pubmed publisher
    ..Implementation of these models has the potential to improve current risk stratification, although prospective validation will still be necessary. ..