Karakiewicz Pierre I, Briganti Alberto, Chun Felix K-H, Trinh Quoc-Dien, Perrotte Paul, Ficarra Vincenzo, Cindolo Luca, De la Taille Alexandre, Tostain Jacques, Mulders Peter F A, Salomon Laurent, Zigeuner Richard, Prayer-Galetti Tommaso, Chautard Denis, Valeri Antoine, Lechevallier Eric, Descotes Jean-Luc, Lang Herve, Mejean Arnaud, Patard Jean-Jacques
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
J Clin Oncol. 2007 Apr 10;25(11):1316-22. doi: 10.1200/JCO.2006.06.1218.
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.
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.
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.
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.
我们检验了这样一个假设，即在预后列线图中使用传统预测变量可改善对肾癌特异性生存的预测。
使用了两组因肾皮质肿瘤接受根治性或部分肾切除术的患者队列：一组（n = 2530）用于列线图的开发和内部验证（200次自抽样重采样），另一组（n = 1422）用于外部验证。Cox比例风险回归分析对2002年TNM分期、肿瘤大小、富尔曼分级、组织学亚型、局部症状、年龄和性别进行建模。将列线图的准确性与既定的分期方案进行比较。
598例（23.6%）患者出现癌症特异性死亡，而200例（7.9%）因其他原因死亡。随访时间为0.1至286个月（中位数为38.8个月）。肾切除术后1、2、5和10年对列线图的外部验证显示预测准确性分别为87.8%、89.2%、86.7%和88.8%。相反，在2年和5年进行预测的替代分期方案准确性较低，2年和5年的估计值分别为86.1%（P = 0.006）和83.9%（P = 0.02），可证明这一点。
新的列线图更具时效性，能在更长时间内进行预测，与在2年和5年进行预测的替代方案相比，预测准确性分别提高了3.1%和2.8%。
