Department of Urology, Air Force Medical Center, PLA, Air Force Medical University, Beijing, China; Department of Traditional Chinese Medicine, The Sixth Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China; Department of Urology, The Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China.
Department of Urology, The Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China.
Clin Genitourin Cancer. 2024 Dec;22(6):102196. doi: 10.1016/j.clgc.2024.102196. Epub 2024 Aug 12.
To establish a nomogram predicting postoperative recurrence-free survival (RFS) in patients with nonmetastatic renal cell carcinoma (RCC) of pathological T3a (pT3a) stage undergoing nephrectomy.
A retrospective review included 668 patients with pT3a RCC between 2008 and 2019, randomly divided into training and validation groups (7:3 ratio). Cox regression analysis established the RFS-predicting nomogram in the training group. Nomogram performance was assessed using Harrell's concordance index (C-index), time-dependent receiver operating characteristic curve, decision curve analysis, and Kaplan-Meier survival analysis.
Of the 668 patients with pT3a RCC, 167 patients experienced local recurrence or distant metastasis. Using multivariable Cox regression analysis, tumor size, ISUP grade, necrosis, capsular invasion, pT3a invasion pattern were identified as the significant predictors for RFS to establish the nomogram. The C-index of the nomogram was 0.753 (95% CI, 0.710-0.796) and 0.762 (95% CI, 0.701-0.822) for the training and validating group, respectively. The areas under the 1-year, 3-year and 5-year RFS receiver operating characteristic curves were 0.814, 0.769 and 0.768, respectively. Decision curve analysis showed the optimal application of the model in clinical decision-making. Patients with low risk T3a RCC have better RFS than those with high risk T3a RCC.
Tumor size, ISUP grade, necrosis, capsular invasion and T3a invasion patterns were independent risk factors for worse RFS in patients with nonmetastatic pT3a RCC. The current nomogram could effectively predict the RFS of patients with nonmetastatic pT3a RCC.
建立一个列线图，以预测接受肾切除术的非转移性肾细胞癌（RCC）pT3a 期（pT3a）患者的术后无复发生存率（RFS）。
回顾性分析了 2008 年至 2019 年间 668 例 pT3a RCC 患者，随机分为训练组和验证组（比例为 7:3）。Cox 回归分析在训练组中建立了 RFS 预测列线图。使用 Harrell 一致性指数（C-index）、时间依赖性接收者操作特征曲线、决策曲线分析和 Kaplan-Meier 生存分析评估列线图的性能。
在 668 例 pT3a RCC 患者中，有 167 例患者发生局部复发或远处转移。使用多变量 Cox 回归分析，肿瘤大小、ISUP 分级、坏死、包膜侵犯、pT3a 侵犯模式被确定为 RFS 的显著预测因素，建立了列线图。列线图的 C-index 在训练组和验证组中分别为 0.753（95%可信区间，0.710-0.796）和 0.762（95%可信区间，0.701-0.822）。1 年、3 年和 5 年 RFS 接收器工作特征曲线下面积分别为 0.814、0.769 和 0.768。决策曲线分析显示，该模型在临床决策中的最佳应用。低危 pT3a RCC 患者的 RFS 优于高危 pT3a RCC 患者。
肿瘤大小、ISUP 分级、坏死、包膜侵犯和 T3a 侵犯模式是非转移性 pT3a RCC 患者 RFS 较差的独立危险因素。目前的列线图可以有效地预测非转移性 pT3a RCC 患者的 RFS。
