Evaluating overall survival and competing risks of death in patients with localized renal cell carcinoma using a comprehensive nomogram.
OBJECTIVE
Many patients with localized node-negative renal cell carcinoma (RCC) are elderly with competing comorbidities. Their overall survival benefit after surgical treatment is unknown. We reviewed cases in the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the impact of kidney cancer versus competing causes of death in patients with localized RCC and develop a comprehensive nomogram to quantitate survival differences.


METHODS
We identified individuals with localized, surgically treated clear-cell, papillary, or chromophobe RCC in SEER (1988 through 2003). We used Fine and Gray competing risks proportional hazards regressions to predict 5-year probabilities of three competing mortality outcomes: kidney cancer death, other cancer death, and noncancer death.


RESULTS
We identified 30,801 cases of localized RCC (median age, 62 years; median tumor size, 4.5 cm). Five-year probabilities of kidney cancer death, other cancer death, and noncancer death were 4%, 7%, and 11%, respectively. Age was strongly predictive of mortality and most predictive of nonkidney cancer deaths (P < .001). Increasing tumor size was related to death from RCC and inversely related to noncancer deaths (P < .001). Racial differences in outcomes were most pronounced for nonkidney cancer deaths (P < .001). Men were more likely to die than women from all causes (P < .002). This nomogram integrates commonly available factors into a useful tool for comparing competing risks of death.


CONCLUSIONS
Management of localized RCC must consider competing causes of mortality, particularly in elderly populations. Effective decision making requires treatment trade-off calculations. We present a tool to quantitate competing causes of mortality in patients with localized RCC.
Kutikov
Alexander
A
Department of Urological Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA 19111, USA.
Egleston
Brian L
BL
Wong
Yu-Ning
YN
Uzzo
Robert G
RG
D000367:Age Factors; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011336:Probability; D018570:Risk Assessment; D018426:SEER Program; D012737:Sex Factors