Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 77030, USA.
Eur Urol. 2013 May;63(5):947-52. doi: 10.1016/j.eururo.2012.11.040. Epub 2012 Nov 23.
There is limited evidence to guide patient selection for cytoreductive nephrectomy (CN) following the diagnosis of metastatic renal cell carcinoma (mRCC).
Given the significant variability in oncologic outcomes following surgery, we sought to develop clinically relevant, individualized, multivariable models for the prediction of cancer-specific survival at 6 and 12 mo after CN. The development of this nomogram will better help clinicians select patients for cytoreductive surgery.
DESIGN, SETTING, AND PARTICIPANTS: We identified 601 consecutive patients who underwent CN for kidney cancer at a single tertiary cancer center.
CN for mRCC.
The development cohort was used to select predictive variables from a large group of candidate predictors. The discrimination, calibration, and decision curves were corrected for overfit using 10-fold crossvalidation that included stepwise variable selection.
With a median follow-up of 65 mo (range: 6-199) for the entire cohort, 110 and 215 patients died from kidney cancer at 6 and 12 mo after surgery, respectively. For the preoperative model, serum albumin and serum lactate dehydrogenase were included. Final pathologic primary tumor stage, nodal stage, and receipt of blood transfusion were added to the previously mentioned parameters for the postoperative model. Preoperative and postoperative nomograms demonstrated good discrimination of 0.76 and 0.74, respectively, when applied to the validation data set. Both models demonstrated excellent calibration and a good net benefit over large ranges of threshold probabilities. The retrospective study design is the major limitation of this study.
We have developed models for accurate prediction of cancer-specific survival after CN, using either preoperative or postoperative variables. While these tools need validation in independent cohorts, our results suggest that the models are informative and can be used to aid in clinical decision making.
在诊断出转移性肾细胞癌（mRCC）后，用于指导细胞减灭性肾切除术（CN）患者选择的证据有限。
鉴于手术后肿瘤学结果存在显著差异，我们试图为 CN 后 6 个月和 12 个月的癌症特异性生存建立临床相关的、个体化的多变量模型。该列线图的开发将更好地帮助临床医生选择接受细胞减灭性手术的患者。
设计、地点和参与者：我们在一家单一的三级癌症中心确定了 601 例连续接受 CN 治疗的肾癌患者。
CN 治疗 mRCC。
开发队列用于从大量候选预测因子中选择预测变量。使用包括逐步变量选择的 10 倍交叉验证对区分度、校准和决策曲线进行了校正，以避免过度拟合。
对于整个队列，中位随访时间为 65 个月（范围：6-199 个月），110 例和 215 例患者分别在手术后 6 个月和 12 个月死于肾癌。对于术前模型，包括血清白蛋白和血清乳酸脱氢酶。术后模型中增加了最终病理原发性肿瘤分期、淋巴结分期和输血的接受情况。术前和术后列线图在应用于验证数据集时，分别显示出良好的区分度 0.76 和 0.74。两个模型均显示出良好的校准度和在较大阈值概率范围内的良好净收益。回顾性研究设计是本研究的主要局限性。
我们使用术前或术后变量为 CN 后癌症特异性生存的准确预测建立了模型。虽然这些工具需要在独立队列中验证，但我们的结果表明这些模型具有信息性，可以用于辅助临床决策。
