Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Cancer. 2011 Dec 1;117(23):5314-24. doi: 10.1002/cncr.26193. Epub 2011 May 12.
Outcomes after surgical removal of localized renal cell carcinoma (RCC) are variable. There have been multiple prognostic nomograms and risk groups developed for estimation of survival outcomes, with different models in use for evaluating patient eligibility in ongoing trials of adjuvant therapy. The authors aimed to establish the most useful prognostic model for patients with localized RCC to guide trial design, biomarker research, and clinical counseling.
A total of 390 consecutive patients who underwent nephrectomy for sporadic localized RCC in a tertiary institution (1990-2006) with 65 months median follow-up were retrospectively evaluated. The Karakiewicz nomogram, the Kattan nomogram, the Sorbellini nomogram, and the Leibovich model were compared in predicting survival outcomes (overall survival, cancer-specific survival, and freedom from recurrence) using likelihood analysis, adequacy indices, decision curve analysis, calibration, and concordance indices.
Overall, the Karakiewicz nomogram outperformed the Kattan nomogram, the Sorbellini nomogram, and the Leibovich model. Highly improved accuracy was seen using the Karakiewicz nomogram in survival prediction, using likelihood ratio analysis in bivariate models including the competing prognostic models. The Karakiewicz nomogram showed higher adequacy and concordance indices and improved clinical benefit relative to all other nomograms. All 4 models were reasonably calibrated. Exploratory comparisons of prespecified discretized Karakiewicz nomograms and the SORCE trial recruitment criteria (a discretized Leibovich model) of high-risk patients favored the discretized Karakiewicz nomograms.
The Karakiewicz nomogram was shown to be superior to the other tested nomograms and risk groups in predicting survival outcomes in localized RCC. Routine integration of this model into trial design and biomarker research should be considered.
局限性肾细胞癌（RCC）手术后的结果各不相同。已经开发了多种预后列线图和风险组来评估生存结果，不同的模型用于评估辅助治疗试验中患者的入选资格。作者旨在为局限性 RCC 患者建立最有用的预后模型，以指导试验设计、生物标志物研究和临床咨询。
回顾性评估了一家三级医疗机构（1990-2006 年）连续 390 例接受肾切除术治疗散发性局限性 RCC 的患者，中位随访时间为 65 个月。使用似然分析、充分性指数、决策曲线分析、校准和一致性指数比较了 Karakiewicz 列线图、Kattan 列线图、Sorbellini 列线图和 Leibovich 模型在预测生存结果（总生存、癌症特异性生存和无复发生存）方面的表现。
总体而言，Karakiewicz 列线图优于 Kattan 列线图、Sorbellini 列线图和 Leibovich 模型。在包含竞争预后模型的双变量模型中，使用似然比分析，Karakiewicz 列线图在生存预测方面的准确性有了显著提高。Karakiewicz 列线图具有更高的充分性和一致性指数，与所有其他列线图相比，具有更高的临床获益。所有 4 种模型的校准都比较合理。对预先指定的 Karakiewicz 列线图离散化和高危患者的 SORCE 试验招募标准（离散化 Leibovich 模型）的探索性比较，支持 Karakiewicz 列线图离散化。
Karakiewicz 列线图在预测局限性 RCC 的生存结果方面优于其他测试的列线图和风险组。应考虑将该模型常规纳入试验设计和生物标志物研究。
