title: A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma.
abstract: OBJECTIVE
  Few published studies have simultaneously analyzed multiple prognostic factors to predict recurrence after surgery for conventional clear cell renal cortical carcinomas. We developed and performed external validation of a postoperative nomogram for this purpose. We used a prospectively updated database of more than 1,400 patients treated at a single institution.
  
  
  METHODS
  From January 1989 to August 2002, 833 nephrectomies (partial and radical) for renal cell carcinoma of conventional clear cell histology performed at Memorial Sloan-Kettering Cancer Center were reviewed from the center's kidney database. Patients with von Hippel-Lindau disease or familial syndromes, as well as patients presenting with synchronous bilateral renal masses, or distant metastases or metastatic regional lymph nodes before or at surgery were excluded from study. We modeled clinicopathological data and disease followup for 701 patients with conventional clear cell renal cell carcinoma. Prognostic variables for the nomogram included pathological stage, Fuhrman grade, tumor size, necrosis, vascular invasion and clinical presentation (ie incidental asymptomatic, locally symptomatic or systemically symptomatic).
  
  
  RESULTS
  Disease recurrence was noted in 72 of 701 patients. Those patients without evidence of disease had a median and maximum followup of 32 and 120 months, respectively. The 5-year probability of freedom from recurrence for the patient cohort was 80.9% (95% confidence interval 75.7% to 85.1%). A nomogram was designed based on a Cox proportional hazards regression model. Following external validation predictions by the nomogram appeared accurate and discriminating, and the concordance index was 0.82.
  
  
  CONCLUSIONS
  A nomogram has been developed that can be used to predict the 5-year probability of freedom from recurrence for patients with conventional clear cell renal cell carcinoma. This nomogram may be useful for patient counseling, clinical trial design and effective patient followup strategies.
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Sorbellini
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Mark E
authors.initials: ME
authors.lastname: Snyder
authors.forename: Victor
authors.initials: V
authors.lastname: Reuter
authors.forename: Robert
authors.initials: R
authors.lastname: Motzer
authors.forename: Manlio
authors.initials: M
authors.lastname: Goetzl
authors.forename: James
authors.initials: J
authors.lastname: McKiernan
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D049451:Nomograms; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis