Yan Haicui, Wei Xiyi, Wu Aimin, Sha Yeqin, Li Xiao, Qi Feng
Department of Oncology, The Second People's Hospital of Lianyungang, Lianyungang 222000, China.
First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China.
Transl Androl Urol. 2020 Jun;9(3):1146-1158. doi: 10.21037/tau-19-807.
To establish and validate nomograms for predicting the overall survival (OS) and cancer-specific survival (CSS) in patients with papillary renal cell carcinoma (pRCC).
Patients diagnosed with pRCC between 2010 and 2014 in the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively included in this study and divided into training and validation groups randomly. Uni- and multivariate Cox regression analyses were used to identify significant variables related to OS and CSS in the training group. Based on results of multivariate Cox regression analysis, nomograms for 3- and 5-year CSS and OS were established, respectively. Additionally, Kaplan-Meier (KM) survival curves were produced to learn the actual effects of different variables. Finally, the nomograms were evaluated both in the training group and the validation group using the area under the receiver operating characteristic (ROC) curve, the concordance index (C-index) and calibration curves.
A total of 4,859 eligible patients were enrolled, with 3,403 categorized into the training group and 1,456 into the validation group. Seven factors [age, T stage, N stage, M stage, use of surgery/lymph node removal (LNR) and insurance status] were significantly related to OS and seven factors (age, T stage, N stage, M stage and use of surgery/chemotherapy/LNR) were significantly associated with CSS. These factors were eventually included in the predictive nomograms. The C-indexes for OS in the training and validation groups were 0.764 and 0.723 respectively, and 0.859 and 0.824 for CSS. The 3- and 5-year AUCs for OS were 0.779 and 0.752 in the training cohort, and 0.749 and 0.722 in the validation cohort. Similarly, 3- and 5-year AUCs for OS were 0.871 and 0.844 in the training cohort, and 0.853 and 0.822 in the validation group. Finally, the calibration curves suggested that the predictive nomograms had a good consistency between the observed and the predicted survival.
It was the first time to develop nomograms to predict the survival outcomes of pRCC patients. The prognostic nomograms were reliable with high accuracy, which might have guiding significance for clinical practice.
建立并验证用于预测乳头状肾细胞癌（pRCC）患者总生存期（OS）和癌症特异性生存期（CSS）的列线图。
回顾性纳入2010年至2014年在监测、流行病学和最终结果（SEER）数据库中诊断为pRCC的患者，并随机分为训练组和验证组。在训练组中，采用单因素和多因素Cox回归分析来确定与OS和CSS相关的显著变量。基于多因素Cox回归分析结果，分别建立了3年和5年CSS及OS的列线图。此外，绘制Kaplan-Meier（KM）生存曲线以了解不同变量的实际影响。最后，使用受试者操作特征（ROC）曲线下面积、一致性指数（C-index）和校准曲线在训练组和验证组中对列线图进行评估。
共纳入4859例符合条件的患者，其中3403例归入训练组，1456例归入验证组。七个因素[年龄、T分期、N分期、M分期、手术/淋巴结清扫（LNR）的使用情况和保险状况]与OS显著相关，七个因素（年龄、T分期、N分期、M分期以及手术/化疗/LNR的使用情况）与CSS显著相关。这些因素最终被纳入预测列线图。训练组和验证组中OS的C-index分别为0.764和0.723，CSS的C-index分别为0.859和0.824。训练队列中OS的3年和5年AUC分别为0.779和0.752，验证队列中分别为0.749和0.722。同样，训练队列中CSS的3年和5年AUC分别为0.871和0.844，验证组中分别为0.853和0.822。最后，校准曲线表明预测列线图在观察到的和预测的生存期之间具有良好的一致性。
首次开发列线图来预测pRCC患者的生存结局。预后列线图可靠且准确性高，可能对临床实践具有指导意义。
