Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany.
Department of Urology, Elblandklinikum Riesa, Weinbergstrasse 8, 01589, Riesa, Germany.
Int J Clin Oncol. 2020 Jan;25(1):145-150. doi: 10.1007/s10147-019-01530-x. Epub 2019 Aug 30.
Based on data retrieved from a comprehensive multicenter database, we externally validated a published postoperative nomogram for the prediction of disease-specific survival (DSS) in patients with papillary renal cell carcinoma (papRCC).
A multicenter database containing data of 2325 patients with surgically treated papRCC was used as validation cohort. After exclusion of patients with missing data and patients included in the development cohort, 1372 patients were included in the final analysis. DSS-probabilities according to the nomogram were calculated and compared to actual DSS-probabilities. Subsequently, calibration plots and decision curve analyses were applied.
The median follow-up was 38 months (IQR 11.8-80.7). Median DSS was not reached. The c-index of the nomogram was 0.71 (95% CI 0.60-0.83). A sensitivity analysis including only patients operated after 1998 delivered a c-index of 0.84 (95% CI 0.77-0.92). Calibration plots showed slight underestimation of nomogram-predicted DSS in probability ranges below 90%: median nomogram-predicted 5-year DSS in the range below 90% was 55% (IQR 20-80), but the median actual 5-year DSS in the same group was 58% (95% CI 52-65). Decision-curve analysis showed a positive net-benefit for probability ranges between a DSS probability of 5% and 85%.
The nomogram performance was satisfactory for almost all DSS probabilities; hence it can be recommended for application in clinical routine and for counseling of patients with papRCC.
基于从一个全面的多中心数据库中检索的数据，我们对一个已发表的用于预测乳头状肾细胞癌（papRCC）患者疾病特异性生存（DSS）的术后列线图进行了外部验证。
使用包含 2325 例接受手术治疗的 papRCC 患者数据的多中心数据库作为验证队列。排除缺失数据的患者和包含在开发队列中的患者后，最终分析纳入了 1372 例患者。根据列线图计算 DSS 概率，并与实际 DSS 概率进行比较。随后应用校准图和决策曲线分析。
中位随访时间为 38 个月（IQR 11.8-80.7）。中位 DSS 未达到。列线图的 C 指数为 0.71（95%CI 0.60-0.83）。仅纳入 1998 年后手术的患者进行的敏感性分析得出的 C 指数为 0.84（95%CI 0.77-0.92）。校准图显示，在概率范围低于 90%时，列线图预测的 DSS 存在轻微低估：低于 90%的范围内，列线图预测的 5 年 DSS 中位数为 55%（IQR 20-80），而同一组的实际 5 年 DSS 中位数为 58%（95%CI 52-65）。决策曲线分析表明，在 DSS 概率为 5%至 85%的范围内，存在正的净获益。
该列线图在几乎所有 DSS 概率下的性能均令人满意；因此，它可以推荐用于临床常规应用和乳头状肾细胞癌患者的咨询。
