Liu Zheng, Lv Jiaju, Ding Kejia, Fu Qiang, Cao Qingwei, Wang Facheng
Department of Urology, Shandong Provincial Hospital, Shandong University, Jinan, China.
Int J Urol. 2009 Mar;16(3):268-73. doi: 10.1111/j.1442-2042.2008.02229.x. Epub 2008 Dec 14.
To explore the applicability of the current prognostic models for nonmetastatic renal cell carcinoma in the Chinese population based on a single center experience.
Clinical and pathological variables of 653 nonmetastatic renal cell carcinoma patients were retrospectively reviewed. Seven models were used to predict the prognosis, including the Yaycioglu model, the Cindolo model, the University of California Los Angeles Integrated Staging System model, the stage, size, grade, and necrosis model, the Kattan nomogram, the Sorbellini nomogram and the Karakiewicz nomogram. Three different end-points were used for validation, including overall survival, cancer-specific survival, and recurrence-free survival. Survival was estimated using the Kaplan-Meier method. Discriminating ability was assessed using the Harrell's concordance-index.
At the last follow up, 159 patients had died due to various causes, and disease recurrence occurred in 156 patients. The discriminating ability of all models was confirmed in the Chinese population. Nomograms discriminate better than algorithms, regardless of end-points. The Kattan nomogram was the most accurate, with the highest concordance-indexes of 0.752, 0.793 and 0.841 for overall survival, cancer-specific survival, and recurrence-free survival, respectively.
The current prognostic models were developed and validated entirely based on Caucasian populations. This study defines the general applicability of the models for Chinese patients with nonmetastatic renal cell carcinoma treated with nephrectomy. The Kattan model was found to be the most accurate. The Cindolo model performed well in some situations, although only including clinical presentation and size of tumor. Therefore, models should be chosen according to different environments and purposes.
基于单中心经验，探讨当前非转移性肾细胞癌预后模型在中国人群中的适用性。
回顾性分析653例非转移性肾细胞癌患者的临床和病理变量。使用7种模型预测预后，包括亚伊乔奥卢模型、钦多洛模型、加利福尼亚大学洛杉矶分校综合分期系统模型、分期、大小、分级和坏死模型、卡坦列线图、索尔贝利尼列线图和卡拉基耶维茨列线图。使用3种不同的终点进行验证，包括总生存期、癌症特异性生存期和无复发生存期。采用Kaplan-Meier法估计生存期。使用Harrell一致性指数评估区分能力。
在最后一次随访时，159例患者因各种原因死亡，156例患者出现疾病复发。所有模型的区分能力在中国人群中得到证实。无论终点如何，列线图的区分效果均优于算法。卡坦列线图最为准确，总生存期、癌症特异性生存期和无复发生存期的一致性指数分别为0.752、0.793和0.841。
当前的预后模型完全基于白种人群开发和验证。本研究明确了这些模型对接受肾切除术治疗的中国非转移性肾细胞癌患者的普遍适用性。发现卡坦模型最为准确。钦多洛模型在某些情况下表现良好，尽管仅包括临床表现和肿瘤大小。因此，应根据不同的环境和目的选择模型。
