Multi-institutional validation of a new renal cancer-specific survival nomogram.
OBJECTIVE
We tested the hypothesis that the prediction of renal cancer-specific survival can be improved if traditional predictor variables are used within a prognostic nomogram.


METHODS
Two cohorts of patients treated with either radical or partial nephrectomy for renal cortical tumors were used: one (n = 2,530) for nomogram development and for internal validation (200 bootstrap resamples), and a second (n = 1,422) for external validation. Cox proportional hazards regression analyses modeled the 2002 TNM stages, tumor size, Fuhrman grade, histologic subtype, local symptoms, age, and sex. The accuracy of the nomogram was compared with an established staging scheme.


RESULTS
Cancer-specific mortality was observed in 598 (23.6%) patients, whereas 200 (7.9%) died as a result of other causes. Follow-up ranged from 0.1 to 286 months (median, 38.8 months). External validation of the nomogram at 1, 2, 5, and 10 years after nephrectomy revealed predictive accuracy of 87.8%, 89.2%, 86.7%, and 88.8%, respectively. Conversely, the alternative staging scheme predicting at 2 and 5 years was less accurate, as evidenced by 86.1% (P = .006) and 83.9% (P = .02) estimates.


CONCLUSIONS
The new nomogram is more contemporary, provides predictions that reach further in time and, compared with its alternative, which predicts at 2 and 5 years, generates 3.1% and 2.8% more accurate predictions, respectively.
Karakiewicz
Pierre I
PI
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada. pierre.karakiewicz@umontreal.ca
Briganti
Alberto
A
Chun
Felix K-H
FK
Trinh
Quoc-Dien
QD
Perrotte
Paul
P
Ficarra
Vincenzo
V
Cindolo
Luca
L
De la Taille
Alexandre
A
Tostain
Jacques
J
Mulders
Peter F A
PF
Salomon
Laurent
L
Zigeuner
Richard
R
Prayer-Galetti
Tommaso
T
Chautard
Denis
D
Valeri
Antoine
A
Lechevallier
Eric
E
Descotes
Jean-Luc
JL
Lang
Herve
H
Mejean
Arnaud
A
Patard
Jean-Jacques
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D049451:Nomograms; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D016019:Survival Analysis