title: Can the Kattan nomogram still accurately predict prognosis in renal cell carcinoma using the revised 2010 tumor-nodes-metastasis reclassification?
abstract: The Kattan nomogram has been used in renal cell cancer to predict progression-free survival after nephrectomy. Tumor-nodes-metastasis staging is essential for the calculation of this score. The effect of the recent 2010 revision to the tumor-nodes-metastasis classification on the predictive ability of the Kattan nomogram was studied. All patients having radical nephrectomy for renal cell cancer in the 5-year period of 2004-2008 at a tertiary referral center were included. Pathological and radiological records were reviewed to identify tumor-nodes-metastasis stage (2002 and 2010 classifications). Kattan scores were calculated for the 2002 and 2010 tumor-nodes-metastasis stages, and the effect on survival predictions were compared with actual outcomes. A total of 291 patients with non-metastatic renal cell cancer were identified. Revision of the tumor-nodes-metastasis staging from the 2002 to 2010 classification resulted in an increase in the number of patients with stage pT3a (from 30 to 75), a reduction in the patients with stage pT3b (from 57 to 10) and a small increase in stage pT4 cases (1 to 3). This altered the proportion of patients in the Kattan prognostic of "good" (from 61% to 69%), "intermediate" (from 29% to 22%) and "poor" (from 10% to 8%). The overall median predicted 5-year progression-free survival was 79.8% with 2002 tumor-nodes-metastasis, and 81.8% with 2010 tumor-nodes-metastasis. Actual 5-year progression-free survival was 83.0%, which was not significantly different from that predicted using either tumor-nodes-metastasis classification (P = 0.66). On comparing the new 2010 and old 2002 tumor-nodes-metastasis classification in our cohort, we showed the predictive ability of the Kattan nomogram remained unaltered.
authors.affiliation: Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK.
authors.forename: Rajan
authors.initials: R
authors.lastname: Veeratterapillay
authors.forename: Simren
authors.initials: S
authors.lastname: Rakhra
authors.forename: Amira
authors.initials: A
authors.lastname: El-Sherif
authors.forename: Mark
authors.initials: M
authors.lastname: Johnson
authors.forename: Naeem
authors.initials: N
authors.lastname: Soomro
authors.forename: Rakesh
authors.initials: R
authors.lastname: Heer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D007680:Kidney Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049451:Nomograms; D011379:Prognosis; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult