Development of accurate models for individualized prediction of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma Journal Article


Authors: Margulis, V.; Shariat, S. F.; Rapoport, Y.; Rink, M.; Sjoberg, D. D.; Tannir, N. M.; Abel, E. J.; Culp, S. H.; Tamboli, P.; Wood, C. G.
Article Title: Development of accurate models for individualized prediction of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma
Abstract: Background: There is limited evidence to guide patient selection for cytoreductive nephrectomy (CN) following the diagnosis of metastatic renal cell carcinoma (mRCC). Objective: 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. Intervention: CN for mRCC. Outcome measurements and statistical analysis: 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. Results and limitations: 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. Conclusions: 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. © 2012 Published by Elsevier B.V. on behalf of European Association of Urology.
Keywords: adult; treatment outcome; disease-free survival; middle aged; retrospective studies; major clinical study; overall survival; postoperative period; patient selection; cancer staging; outcome assessment; follow up; neoplasm staging; cytoreductive surgery; accuracy; logistic models; tumor markers, biological; cohort analysis; odds ratio; risk factors; retrospective study; renal cell carcinoma; kidney neoplasms; nephrectomy; time factors; risk assessment; simulation; cancer center; preoperative period; carcinoma, renal cell; cancer specific survival; patient safety; blood transfusion; texas; lactate dehydrogenase; multivariate analysis; kidney metastasis; lactate dehydrogenase blood level; l-lactate dehydrogenase; predictive value; decision support techniques; prediction models; serum albumin; individualized medicine; cytoreductive nephrectomy; transfusion; albumin blood level; oncologic outcome; cancer prognosis; tertiary care centers
Journal Title: European Urology
Volume: 63
Issue: 5
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2013-05-01
Start Page: 947
End Page: 952
Language: English
PROVIDER: scopus
PUBMED: 23273681
DOI: 10.1016/j.eururo.2012.11.040
PMCID: PMC4378834
DOI/URL:
Notes: --- - "Export Date: 1 May 2013" - "CODEN: EUURA" - ":doi 10.1016/j.eururo.2012.11.040" - "Source: Scopus"
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  1. Daniel D. Sjoberg
    234 Sjoberg