# SSIGN score for clear cell RCC (Frank 2002) SSIGN score Status: LIVE Price: $0.005 USDC `GET /api/calc/ssign` HTML: https://magentlab.com/docs/ssign Markdown: https://magentlab.com/docs/ssign.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the Frank 2002 SSIGN score from caller-assigned 1997 TNM, tumor size, nuclear grade, and coagulative necrosis, and return the published cancer-specific survival row. ## When to use When an agent already has 1997 pathologic T, N, and M, tumor size in cm, nuclear grade, and coagulative necrosis and needs the published SSIGN total and CSS row. magent does not stage the tumor or read slides, and must not invent an RCC diagnosis or a later-TNM conversion. ## When not to use - Not a medical device. magent does not stage the tumor or read pathology. - 1997 TNM weights from Frank 2002 only. Not 2002 or 2010 TNM. pT4 scores 0 as published. The caller maps TNM; magent does not convert later editions. - Size uses unrounded cm; 5.0 cm scores 2. Magent clamp 0.1-40 cm is not a published range. - Published CSS percents are Frank 2002 cohort Kaplan-Meier rows, not an individualized prediction or a treatment recommendation. - Not UISS. Not an RCC diagnosis. Clear-cell radical-nephrectomy cohort only. ## Formula ``` SSIGN = t_1997 (t1 0, t2 1, t3/t3a/t3b/t3c 2, t4 0) + n_1997 (n0/nx 0, n1/n2 2) + m_1997 (m0 0, m1 4) + tumor_size_cm >=5 2 + fuhrman (1-2 0, 3 1, 4 3) + necrosis 2; Frank 2002 1997 TNM only; max 15; CSS rows 0-1, 2, 3, 4, 5, 6, 7, 8, 9, ge_10 ``` ## Citation [An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score](https://doi.org/10.1016/s0022-5347(05)64153-5) Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H J Urol. 2002;168(6):2395-2400 DOI: [10.1016/s0022-5347(05)64153-5](https://doi.org/10.1016/s0022-5347(05)64153-5) ## Worked example ### Lowest-risk pT1 N0 M0 size <5 cm grade 1 no necrosis Given: `fuhrman=1, m_1997=m0, n_1997=n0, necrosis=false, t_1997=t1, tumor_size_cm=3` 1. t1 → 0; n0 → 0; m0 → 0 2. size 3 cm <5 → 0; fuhrman 1 → 0; necrosis false → 0 3. Score = 0 (max 15); css_band = 0-1 (100.0 / 99.7 / 99.4 / 98.7 / 97.1 at 1/3/5/7/10 years) ### Score 10 ge_10 CSS row Given: `fuhrman=1, m_1997=m1, n_1997=n1, necrosis=false, t_1997=t3, tumor_size_cm=6` 1. t3 → 2; n1 → 2; m1 → 4; size 6 cm ≥5 → 2; fuhrman 1 → 0; necrosis false → 0 2. Score = 10 (max 15); css_band = ge_10 (36.2 / 11.9 / 7.4 / 4.6 / 4.6 at 1/3/5/7/10 years) ## Also searched as - SSIGN - SSIGN score - Stage Size Grade Necrosis - clear cell RCC SSIGN - Frank 2002 SSIGN - RCC SSIGN - SSIGN renal cell - coagulative necrosis RCC score ## Parameters - `t_1997` (string, required): 1997 pathologic T as assigned by the caller (Frank 2002 SSIGN). t1 scores 0; t2 scores 1; t3, t3a, t3b, or t3c scores 2; t4 scores 0 (published 1997 weight). Not 2002/2010 T1a/T1b. magent does not stage the tumor. - `n_1997` (string, required): 1997 pathologic N as assigned by the caller (Frank 2002 SSIGN). n0 or nx scores 0; n1 or n2 scores 2. magent does not stage nodes. - `m_1997` (string, required): 1997 pathologic M as assigned by the caller (Frank 2002 SSIGN). m0 scores 0; m1 scores 4. magent does not assign M. - `tumor_size_cm` (number, required): Maximum tumor size in cm as assigned by the caller (Frank 2002). Unrounded; 5.0 cm or greater scores 2. Magent clamp 0.1-40, not a published range. magent does not measure the tumor. - `fuhrman` (integer, required): Nuclear grade 1-4 as assigned by the caller (Frank 2002 SSIGN). 1-2 score 0; 3 scores 1; 4 scores 3. Integer 1-4 only; reject 0, 5, 1.5, and roman I. magent does not read slides. - `necrosis` (boolean, required): Coagulative tumor necrosis as assigned by the caller (Frank 2002). true scores 2. magent does not read slides. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/ssign` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "fuhrman": "1", "m_1997": "m0", "n_1997": "n0", "necrosis": "false", "t_1997": "t1", "tumor_size_cm": "3" }, { "fuhrman": "1", "m_1997": "m0", "n_1997": "n0", "necrosis": "false", "t_1997": "t1", "tumor_size_cm": "3" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/ssign Example 200: ```json { "count": 2, "path": "/api/calc/ssign", "items": [ { "components": [ { "value": "t1", "factor": "t_1997", "points": 0, "present": true }, { "value": "n0", "factor": "n_1997", "points": 0, "present": true }, { "value": "m0", "factor": "m_1997", "points": 0, "present": true }, { "value": 3.0, "factor": "tumor_size_cm", "points": 0, "present": false }, { "value": 1, "factor": "fuhrman", "points": 0, "present": true }, { "factor": "necrosis", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H", "doi": "10.1016/s0022-5347(05)64153-5", "id": "frank-2002", "pmid": "12441925", "source": "J Urol. 2002;168(6):2395-2400", "title": "An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score" }, "formula": "ssign", "formula_expression": "SSIGN = t_1997 (t1 0, t2 1, t3/t3a/t3b/t3c 2, t4 0) + n_1997 (n0/nx 0, n1/n2 2) + m_1997 (m0 0, m1 4) + tumor_size_cm >=5 2 + fuhrman (1-2 0, 3 1, 4 3) + necrosis 2; Frank 2002 1997 TNM only; max 15; CSS rows 0-1, 2, 3, 4, 5, 6, 7, 8, 9, ge_10", "max_score": 15, "score": 0, "css_10_year_percent": 97.1, "css_1_year_percent": 100.0, "css_3_year_percent": 99.7, "css_5_year_percent": 99.4, "css_7_year_percent": 98.7, "css_band": "0-1", "fuhrman": 1, "m_1997": "m0", "n_1997": "n0", "necrosis": false, "t_1997": "t1", "tumor_size_cm": 3.0 }, { "components": [ { "value": "t1", "factor": "t_1997", "points": 0, "present": true }, { "value": "n0", "factor": "n_1997", "points": 0, "present": true }, { "value": "m0", "factor": "m_1997", "points": 0, "present": true }, { "value": 3.0, "factor": "tumor_size_cm", "points": 0, "present": false }, { "value": 1, "factor": "fuhrman", "points": 0, "present": true }, { "factor": "necrosis", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H", "doi": "10.1016/s0022-5347(05)64153-5", "id": "frank-2002", "pmid": "12441925", "source": "J Urol. 2002;168(6):2395-2400", "title": "An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score" }, "formula": "ssign", "formula_expression": "SSIGN = t_1997 (t1 0, t2 1, t3/t3a/t3b/t3c 2, t4 0) + n_1997 (n0/nx 0, n1/n2 2) + m_1997 (m0 0, m1 4) + tumor_size_cm >=5 2 + fuhrman (1-2 0, 3 1, 4 3) + necrosis 2; Frank 2002 1997 TNM only; max 15; CSS rows 0-1, 2, 3, 4, 5, 6, 7, 8, 9, ge_10", "max_score": 15, "score": 0, "css_10_year_percent": 97.1, "css_1_year_percent": 100.0, "css_3_year_percent": 99.7, "css_5_year_percent": 99.4, "css_7_year_percent": 98.7, "css_band": "0-1", "fuhrman": 1, "m_1997": "m0", "n_1997": "n0", "necrosis": false, "t_1997": "t1", "tumor_size_cm": 3.0 } ] } ``` ## Response fields - `formula` (string): ssign - `formula_expression` (string): Exact expression used - `score` (integer): Frank 2002 SSIGN integer sum 0-15. Not an RCC diagnosis. - `max_score` (integer): 15 - `css_band` (string): Frank 2002 CSS row key: 0-1, 2, 3, 4, 5, 6, 7, 8, 9, or ge_10. Historical cohort row, not an individualized prediction. - `css_1_year_percent` (number): Frank 2002 estimated 1-year cancer-specific survival percent for this row - `css_3_year_percent` (number): Frank 2002 estimated 3-year cancer-specific survival percent for this row - `css_5_year_percent` (number): Frank 2002 estimated 5-year cancer-specific survival percent for this row - `css_7_year_percent` (number): Frank 2002 estimated 7-year cancer-specific survival percent for this row - `css_10_year_percent` (number): Frank 2002 estimated 10-year cancer-specific survival percent for this row - `t_1997` (string): Caller-assigned 1997 T used (t1, t2, t3, t3a, t3b, t3c, or t4) - `n_1997` (string): Caller-assigned 1997 N used (n0, nx, n1, or n2) - `m_1997` (string): Caller-assigned 1997 M used (m0 or m1) - `tumor_size_cm` (number): Caller-assigned tumor size in cm used (unrounded at the 5 cm boundary) - `fuhrman` (integer): Caller-assigned nuclear grade 1-4 used - `necrosis` (boolean): Caller-assigned coagulative necrosis flag used - `components` (array): Per-factor Frank 2002 SSIGN points - `citation` (object): Frank et al. J Urol 2002 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": "t1", "factor": "t_1997", "points": 0, "present": true }, { "value": "n0", "factor": "n_1997", "points": 0, "present": true }, { "value": "m0", "factor": "m_1997", "points": 0, "present": true }, { "value": 3.0, "factor": "tumor_size_cm", "points": 0, "present": false }, { "value": 1, "factor": "fuhrman", "points": 0, "present": true }, { "factor": "necrosis", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H", "doi": "10.1016/s0022-5347(05)64153-5", "id": "frank-2002", "pmid": "12441925", "source": "J Urol. 2002;168(6):2395-2400", "title": "An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score" }, "formula": "ssign", "formula_expression": "SSIGN = t_1997 (t1 0, t2 1, t3/t3a/t3b/t3c 2, t4 0) + n_1997 (n0/nx 0, n1/n2 2) + m_1997 (m0 0, m1 4) + tumor_size_cm >=5 2 + fuhrman (1-2 0, 3 1, 4 3) + necrosis 2; Frank 2002 1997 TNM only; max 15; CSS rows 0-1, 2, 3, 4, 5, 6, 7, 8, 9, ge_10", "max_score": 15, "score": 0, "css_10_year_percent": 97.1, "css_1_year_percent": 100.0, "css_3_year_percent": 99.7, "css_5_year_percent": 99.4, "css_7_year_percent": 98.7, "css_band": "0-1", "fuhrman": 1, "m_1997": "m0", "n_1997": "n0", "necrosis": false, "t_1997": "t1", "tumor_size_cm": 3.0 } ``` ## Errors - HTTP 400 `invalid_ssign`: t_1997, n_1997, m_1997, tumor_size_cm, fuhrman, and necrosis must match Frank 2002 SSIGN 1997 TNM weights (not later TNM editions). Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [Fuhrman](https://magentlab.com/docs/fuhrman) — Echo the caller-assigned Fuhrman 1982 nuclear grade (1-4) with the published nuclear-feature description. magent does not read slides. Not WHO/ISUP 2016. - [R.E.N.A.L. nephrometry](https://magentlab.com/docs/renal-nephrometry) — Sum the Kutikov 2009 R.E.N.A.L. nephrometry score for a renal mass from four caller-assigned published item points (radius, exophytic/endophytic, nearness, location) and return the integer total (4–12) plus anterior and hilar descriptors. Does not return complexity bands. - [UISS](https://magentlab.com/docs/uiss) — Apply the Zisman 2002 localized N0M0 three-group UISS algorithm to caller-assigned 1997 pathological T, Fuhrman grade, and ECOG PS and return low_risk, intermediate_risk, or high_risk. Does not compute a predicted 5-year disease-specific survival. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.