Hupertan Vincent, Roupret Morgan, Poisson Jean-Francois, Chretien Yves, Dufour Bertrand, Thiounn Nicolas, Mejean Arnaud
Department of Urology, Necker Hospital, GHU Ouest, University Paris V Rene Descartes, Paris, France.
Cancer. 2006 Dec 1;107(11):2604-8. doi: 10.1002/cncr.22313.
The aim of the current study was to establish the predictive accuracy of the Kattan postoperative nomogram for nonmetastatic renal cell carcinoma (RCC) by comparing predictions with actual disease recurrence in patients who underwent surgery in a single center in France.
Between 1985 and 2000, 844 patients were treated for RCC. The following data were collated: age, symptoms, histology, tumor size, grade, TNM 1997 stage, recurrence, and progression. For each patient a prognostic score (predicted probability) for recurrence-free survival (RFS) at 5 years was calculated using the Kattan nomogram. The discriminating ability of the model was assessed by Harrell's concordance index (c-index). Bootstrapping was used to assess confidence intervals. Furthermore, survival was then estimated by the Kaplan-Meier method and Cox proportional hazards regression analysis.
In all, 565 patients (median age, 62 years) were included. At the time of the last follow-up, 81 patients had died and 101 had experienced RCC recurrence. The c-index for RFS (Kattan nomogram) was only 0.607 (95% confidence interval [CI]: 0.576-0.635). The 5-year RFS rate and cancer-specific survival rate were 81.5% and 84.7%, respectively. Of the 4 variables included in the nomogram, only TNM stage was associated with recurrence in a multivariate analysis (Cox analysis) (P = .022).
There was a discrepancy between predicted RFS as estimated by the Kattan nomogram and the likelihood of being recurrence-free at 5 years according to the Cox analysis in the current population of patients. However, until new dynamic models become available clinicians may still improve their predictive ability by using the current nomogram.
本研究的目的是通过比较法国一家单中心接受手术治疗的非转移性肾细胞癌（RCC）患者的预测结果与实际疾病复发情况，来确定卡坦术后列线图对非转移性肾细胞癌的预测准确性。
1985年至2000年间，844例患者接受了RCC治疗。整理了以下数据：年龄、症状、组织学、肿瘤大小、分级、1997年TNM分期、复发和进展情况。使用卡坦列线图为每位患者计算5年无复发生存期（RFS）的预后评分（预测概率）。通过哈雷尔一致性指数（c指数）评估模型的鉴别能力。采用自举法评估置信区间。此外，随后通过Kaplan-Meier法和Cox比例风险回归分析估计生存率。
总共纳入了565例患者（中位年龄62岁）。在最后一次随访时，81例患者死亡，101例经历了RCC复发。RFS（卡坦列线图）的c指数仅为0.607（95%置信区间[CI]：0.576 - 0.635）。5年RFS率和癌症特异性生存率分别为81.5%和84.7%。在列线图包含的4个变量中，多变量分析（Cox分析）显示只有TNM分期与复发相关（P = 0.022）。
在当前患者群体中，卡坦列线图估计的预测RFS与Cox分析得出的5年无复发可能性之间存在差异。然而，在新的动态模型出现之前，临床医生仍可通过使用当前列线图提高其预测能力。
