Hutterer Georg C, Patard Jean-Jacques, Perrotte Paul, Ionescu Constantin, de La Taille Alexandre, Salomon Laurent, Verhoest Gregory, Tostain Jacques, Cindolo Luca, Ficarra Vincenzo, Artibani Walter, Schips Luigi, Zigeuner Richard, Mulders Peter F, Valeri Antoine, Chautard Denis, Descotes Jean-Luc, Rambeaud Jean-Jacques, Mejean Arnaud, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
Int J Cancer. 2007 Dec 1;121(11):2556-61. doi: 10.1002/ijc.23010.
Outcome of patients with renal cell carcinoma nodal metastases (NM) is substantially worse than that of patients with localized disease. This justifies more thorough staging and possibly more aggressive treatment in those at risk of or with established NM. We developed and externally validated a nomogram capable of highly accurately predicting renal cell carcinoma NM in patients without radiographic evidence of distant metastases. Age, symptom classification, tumour size and the pathological nodal stage were available for 4,658 individuals. The data of 2,522 (54.1%) individuals from 7 centers were used to develop a multivariable logistic regression model-based nomogram predicting the individual probability of NM. The remaining data from 2,136 (45.9%) patients from 5 institutions were used for external validation. In the development cohort, 107/2,522 (4.2%) had lymph node metastases vs. 100/2,136 (4.7%) in the external validation cohort. Symptom classification and tumour size were independent predictors of NM in the development cohort. Age failed to reach independent predictor status, but added to discriminant properties of the model. A nomogram based on age, symptom classification and tumour size was 78.4% accurate in predicting the individual probability of NM in the external validation cohort. Our nomogram can contribute to the identification of patients at low risk of NM. This tool can help to risk adjust the need and the extent of nodal staging in patients without known distant metastases. More thorough staging can hopefully better select those in whom adjuvant treatment is necessary. (c) 2007 Wiley-Liss, Inc.
肾细胞癌出现淋巴结转移（NM）的患者的预后明显差于局限性疾病患者。这证明对于有发生NM风险或已确诊NM的患者，需要进行更全面的分期检查，并可能采取更积极的治疗措施。我们开发并在外部验证了一种列线图，它能够在没有远处转移影像学证据的患者中高度准确地预测肾细胞癌的NM情况。4658名个体的年龄、症状分类、肿瘤大小和病理淋巴结分期数据可用。来自7个中心的2522名（54.1%）个体的数据用于建立基于多变量逻辑回归模型的列线图，以预测NM的个体概率。来自5个机构的2136名（45.9%）患者的其余数据用于外部验证。在开发队列中，2522名中有107名（4.2%）发生淋巴结转移，而在外部验证队列中，2136名中有100名（4.7%）发生淋巴结转移。症状分类和肿瘤大小是开发队列中NM的独立预测因素。年龄未达到独立预测因素的地位，但增加了模型的判别特性。基于年龄、症状分类和肿瘤大小的列线图在预测外部验证队列中NM的个体概率时准确率为78.4%。我们的列线图有助于识别NM低风险患者。该工具可帮助对无已知远处转移患者的淋巴结分期需求和范围进行风险调整。更全面的分期有望更好地筛选出需要辅助治疗的患者。（c）2007威利 - 利斯公司
