Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
J Urol. 2017 Oct;198(4):810-816. doi: 10.1016/j.juro.2017.04.066. Epub 2017 Apr 12.
Following surgery for nonmetastatic renal cell carcinoma with tumor thrombus the risk of recurrence is significant but variable among patients. The purpose of this study was to develop and validate a predictive nomogram for individual estimation of recurrence risk following surgery for renal cell carcinoma with venous tumor thrombus.
Comprehensive data were collected on patients with nonmetastatic renal cell carcinoma and thrombus treated at a total of 5 institutions from 2000 to 2013. Independent predictors of recurrent renal cell carcinoma from a competing risks analysis were developed into a nomogram. Predictive accuracy was compared between the development and validation cohorts, and between the nomogram and the UISS (UCLA Integrated Staging System, SSIGN (Stage, Size, Grade and Necrosis) and Sorbellini models.
A total of 636 patients were analyzed, including the development cohort of 465 and the validation cohort of 171. Independent predictors, including tumor diameter, body mass index, preoperative hemoglobin less than the lower limit of normal, thrombus level, perinephric fat invasion and nonclear cell histology, were developed into a nomogram. Estimated 5-year recurrence-free survival was 49% overall. Five-year recurrence-free survival in patients with 0, 1, 2 and more than 2 risk factors was 77%, 53%, 47% and 20%, respectively. Predictive accuracy was similar in the development and validation cohorts (AUC 0.726 and 0.724, respectively). Predictive accuracy of the thrombus nomogram was higher than that of the UISS (AUC 0.726 vs 0.595, p = 0.001), SSIGN (AUC 0.713 vs 0.612, p = 0.04) and Sorbellini models (AUC 0.709 vs 0.638, p = 0.02).
We present a predictive nomogram for postoperative recurrence in patients with nonmetastatic renal cell carcinoma with venous thrombus. Improving individual postoperative risk assessment may allow for better design and analysis of future adjuvant clinical trials.
非转移性肾细胞癌伴静脉肿瘤栓术后复发风险显著，但患者间存在差异。本研究旨在建立并验证一种预测模型，以对肾细胞癌伴静脉肿瘤栓患者术后的复发风险进行个体化评估。
收集了 2000 年至 2013 年间 5 家医院共 636 例非转移性肾细胞癌伴血栓患者的综合数据。通过竞争风险分析确定复发肾细胞癌的独立预测因素，并将其纳入列线图。在开发和验证队列之间以及列线图与 UCLA 综合分期系统（UISS）、SSIGN（分期、大小、分级和坏死）和 SorbeUini 模型之间比较预测准确性。
共分析了 636 例患者，包括 465 例开发队列和 171 例验证队列。包括肿瘤直径、体重指数、术前血红蛋白低于正常值下限、血栓水平、肾周脂肪侵犯和非透明细胞组织学在内的独立预测因素被纳入列线图。总体而言，5 年无复发生存率为 49%。无、1、2 和超过 2 个危险因素的患者 5 年无复发生存率分别为 77%、53%、47%和 20%。开发和验证队列的预测准确性相似（AUC 分别为 0.726 和 0.724）。血栓列线图的预测准确性高于 UISS（AUC 分别为 0.726 与 0.595，p = 0.001）、SSIGN（AUC 分别为 0.713 与 0.612，p = 0.04）和 SorbeUini 模型（AUC 分别为 0.709 与 0.638，p = 0.02）。
我们提出了一种用于非转移性肾细胞癌伴静脉血栓患者术后复发的预测列线图。改善术后个体风险评估可能有助于更好地设计和分析未来的辅助临床试验。
