represents an independent predictor of CSM, and whether HS adds to the ability of other variables to predict CSM. The covariates comprised age, year of surgery, T stage, nodal status, M stage and Fuhrman grade.
RESULTSIn a multivariable model predicting CSM, HS was an independent predictor ( P = 0.03), but failed to improve the accuracy of the model ( + 0.1% gain when HS was included in the model).
CONCLUSIONAlthough we confirmed that HS is an independent predictor for CSM, there was no gain in accuracy when HS was added to standard predictors of CSM. From a practical perspective, this implies that patients with clear cell, papillary and chromophobe HS share similar natural histories after nephrectomy, provided that other cancer characteristics are accounted for. From a statistical perspective, in multivariable models of CSM, the clear cell, papillary and chromophobe HS might be included as a single entity.
Purpose: Cancer-specific mortality (CSM) of patients with primary penile squamous cell carcinoma (PPSCC) may be quite variable. Recently, a nomogram was developed to provide standardized andindividualized mortality predictions. Unfortunately, it relies on a large number (n = 8) of specific variables that are unavailable in routine clinical practice.We attempted to develop a simpler prediction rule with at least equal accuracy in predicting CSM after surgical removal of PPSCC. Experimental Design: The predictive rule was developed on a cohort of 856 patients identified in the 1988 to 2004 Surveillance, Epidemiology and End Results (SEER) database.The predictors consisted of age, race, SEER stage (localized versus regional versus metastatic), tumor grade, type of surgery (excisional biopsy, partial penectomy, and radical penectomy), and of lymph node status (pN 0 versus pN 1-3 versus pN x ). A look-up table based on Cox regression model-derived coefficients was used for prediction of 5-year CSM.The predictive rule accuracy was tested using the Harrell's modification of the area under the receiver operating characteristics curve. Results: SEER stage and histologic grade achieved independent predictor status and qualified for inclusion in the model. The model achieved 73.8% accuracy for prediction of CSM at 5 years after surgery. Both predictors achieved independent predictor status in competing risk regression models addressing CSM, where other cause mortality was controlled for. Conclusion: Despite equivalent accuracy, ourpredictive rulepredicting 5-year CSMinpatients with PPSCC is substantially less complex (2 versus 8 variables) than the previously published model.
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