title: Assessing the accuracy and generalizability of the preoperative and postoperative Karakiewicz nomograms for renal cell carcinoma: results from a multicentre European and US study.
abstract: OBJECTIVE
  To assess the accuracy and generalizability of the pre- and postoperative Karakiewicz nomograms for predicting cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC).
  
  
  METHODS
  This retrospective study included 3231 patients from European and US centres, who were treated by radical or partial nephrectomy for RCC between 1992 and 2010. Prognostic scores for each patient were calculated and the primary endpoint was CSS. Discriminating ability was assessed by Harrell's c-index for censored data. The 'validation by calibration' method proposed by Van Houwelingen was used for checking the calibration of covariate effects. Calibration was graphically explored.
  
  
  RESULTS
  Local and systemic symptoms were present in 23.2% and 9.1% of the patients, respectively. The median follow-up (FU) was 49 months. At the last FU, 408 cancer-related deaths were recorded, Kaplan-Meier estimates of CSS (with 95% confidence intervals [CIs]) at 5 and 10 years were 0.86 (0.84-0.87) and 0.77 (0.75-0.80), respectively. Both nomograms discriminated well. Stratified c-indices for CSS were 0.784 (95% CI 0.753-0.814) for the preoperative nomogram, and 0.842 (95% CI 0.816-0.867) for the postoperative one, with a significant difference between the two values (P < 0.001). The covariate-based predictions on our data for both nomograms were valid. The calibration plots showed no relevant departures from ideal predictions.
  
  
  CONCLUSIONS
  The results suggest that the postoperative Karakiewicz nomogram discriminates substantially better than the preoperative one. These nomogram-based predictions may be used as benchmark data for pretreatment and postoperative decision-making in patients at various stages of RCC.
authors.affiliation: "S. Pio Da Pietrelcina" Hospital, Dept. of Urology, Vasto, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Sabine
authors.initials: S
authors.lastname: Brookman-May
authors.forename: Ottavio
authors.initials: O
authors.lastname: De Cobelli
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.forename: Stefano
authors.initials: S
authors.lastname: Squillacciotti
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
authors.forename: Ioan
authors.initials: I
authors.lastname: Coman
authors.forename: Bodgan
authors.initials: B
authors.lastname: Feciche
authors.forename: Michael
authors.initials: M
authors.lastname: Truss
authors.forename: Manfred P
authors.initials: MP
authors.lastname: Wirth
authors.forename: Orietta
authors.initials: O
authors.lastname: Dalpiaz
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Chromecki
authors.forename: Shahrock F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Manuel
authors.initials: M
authors.lastname: Sanchez-Chapado
authors.forename: Maria del Carmen
authors.initials: Mdel C
authors.lastname: Santiago Martin
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
authors.forename: Luigi
authors.initials: L
authors.lastname: Salzano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lotrecchiano
authors.forename: Francesco
authors.initials: F
authors.lastname: Berardinelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002138:Calibration; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000706:statistics & numerical data; D049451:Nomograms; D016017:Odds Ratio; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: cancer-specific survival; prognosis; renal cell carcinoma