Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy

Cindolo, Luca; Patard, Jean‐Jacques; Chiodini, Paolo; Schips, Luigi; Ficarra, Vincenzo; Tostain, Jacques; Taille, Alexandre de la; Altieri, Vincenzo; Lobel, Bernard; Zigeuner, Richard; Artibani, Walter; Guilhot, François; Abbou, Claude C.; Salzano, L.; Gallo, Ciro

doi:10.1002/cncr.21331

Cited by 201 publications

(127 citation statements)

References 85 publications

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“…Although such factors are consistent predictors of outcome at a population level, they are not always reliable in individual patients (16). Incorporation of factors that may be induced in the host by the presence of the tumor, as investigated in this study, may be valuable.…”

Section: Discussionmentioning

confidence: 98%

Prognostic Factors in Renal Cell Carcinoma: Association of Preoperative Sodium Concentration with Survival

Vasudev

Brown²,

Brown³

et al. 2008

Clinical Cancer Research

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Purpose: Conventional renal cell carcinoma (RCC) has a variable natural history, and determining individual prognosis is important to guide management. We have examined the prognostic significance of a large number of hematologic and biochemical variables, as well as traditional tumor-related factors in patients with RCC. Experimental Design: Patients undergoing nephrectomy for newly diagnosed RCC between September 1998 and March 2005 were invited to participate. Clinical, pathologic, and laboratory data were recorded in each case, and immunophenotyping was carried out on a subset of patients. A planned subset analysis of patients presenting with N0M0 disease was done. Results: Two hundred twelve patients with RCC formed the study population. In addition to tumor-related factors, multivariate analyses revealed preoperative serum sodium concentration to be independently and significantly associated with overall survival and disease-free survival when considered as both a continuous variable and when dichotomized to above and below the median value [139 mmol/L; reference range 135-145 mmol/L, hazard ratio 0.44, 95% confidence interval (95% CI) 0.22-0.88, P = 0.014]. Five-year overall survival estimates for patients above and below the median serum sodium were 67.6% (95% CI 54.2-80.9) and 44.3% (95% CI 32.8-55.8), respectively. These findings persisted in the N0M0 subgroup analysis. Conclusions: We have confirmed the prognostic value of traditional tumor-related factors but, to our knowledge, these are the first data to show that low preoperative sodium concentration may be an important factor associated with reduced survival in patients with RCC, suggesting that serum sodium should be considered with established prognostic variables in modeling survival in RCC.

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Section: Discussionmentioning

confidence: 98%

Prognostic Factors in Renal Cell Carcinoma: Association of Preoperative Sodium Concentration with Survival

Vasudev

Brown²,

Brown³

et al. 2008

Clinical Cancer Research

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“…Multiple studies have demonstrated the superiority of more complex predictive modeling in providing improved accuracy compared with risk group assignment techniques. 16 The nomogram is precise and punctual instrument to estimate the prognosis of a single patient. In this study, patients in clinical stages II and III have a wide variation in their nomogram-predicted risk of developing metastasis: TNM staging alone is inadequate in delineating which of these patients need more aggressive management.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Nomogram Predicting 12-Year Probability of Metastatic Renal Cancer

et al. 2008

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Purpose-For patients with renal masses localized to the kidney, there is currently no preoperative tool to predict the likelihood of metastatic recurrence following surgical intervention. The primary goal of this study was to develop a predictive model that could be used in the preoperative setting.Methods-We pooled institutional databases from Memorial Sloan-Kettering and Mayo Clinic and identified 2,517 patients with renal masses and no concurrent evidence of metatases, who underwent radical or partial nephrectomy and with complete data. Cox proportional hazard regression analyses were used to model pre-operative clinical and radiographic characteristics as predictors for development of metastases following nephrectomy. Internal validation was performed with a statistical bootstrapping technique.Results-Metastatic recurrence developed in 340 of the 2517 patients. Median follow-up for patients without metastatic recurrence was 4.7 years. A nomogram was developed using preoperative characteristics to predict the 12-year likelihood of post-operative metastatic recurrence, with a concordance index (CI) of 0.80. In contrast, the concordance index of pre-operative TNM staging was 0.71. Size of the primary renal mass, evidence of lymphadenopathy or necrosis on pre-operative imaging and the mode of presentation were important predictors for the subsequent development of metastases.Conclusions-We present a pre-operative nomogram that accurately predicts the development of metastatic recurrence following nephrectomy. This nomogram may be potentially useful to identify high-risk patients for clinical trials in neoadjuvant setting.

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“…10 Overall our 5-year RFS from RCC in patients undergoing nephrectomy was 79.2%, consistent with another published rate in the literature of 78% in similar patients. 11 There is currently a debate in the surgical oncology literature about what are appropriate waiting periods from diagnosis to operative intervention. There are only 3 studies in the urological literature that have addressed waiting times for renal cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

Waiting Time From Initial Urological Consultation to Nephrectomy for Renal Cell Carcinoma—Does it Affect Survival?

et al. 2008

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Purpose-We report survival and recurrence outcomes in all patients undergoing radical or partial nephrectomy for renal cell carcinoma, as related to surgical waiting time.Materials and Methods-We retrospectively reviewed the records of 722 patients who underwent surgical resection for renal cell carcinoma. Patients were subdivided by waiting time from the initial urology visit until surgery. Surgical waiting time was evaluated as a continuous variable and by monthly subgroups. Univariate and multivariate analyses were performed to evaluate factors associated with overall, disease specific and recurrence-free survival.Results-Mean time from the first visit to surgery was 1.2 months with 64.1% and 94.3% of patients undergoing surgery within 30 days and within 3 months, respectively. Overall and disease specific survival was not affected by surgical waiting time regardless of how time was analyzed. On univariate analysis 5-year recurrence-free survival was poorer in patients undergoing surgery within 1 month vs more than 1 month (75.7% vs 88.4%, p = 0.02). On multivariate analysis T stage (p <0.0001), grade (p = 0.009), lymph node involvement (p = 0.0001) and histology (p = 0.006) were independent predictors of recurrence-free survival, while surgical waiting time was not (p = 0.18). Surgical waiting time less than 1 month was associated with higher stage and higher grade tumors (p <0.0001 and 0.0006, respectively).Conclusions-Surgical waiting time from initial urological consultation to operative intervention does not adversely affect the outcome of renal cell carcinoma within the time frames analyzed in this study, in which 94% of cases occurred within 3 months. Individual urologist judgment remains a critical factor in the appropriate and timely care of the patient with a suspicious renal mass.

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Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy

Cited by 201 publications

References 85 publications

Prognostic Factors in Renal Cell Carcinoma: Association of Preoperative Sodium Concentration with Survival

Prognostic Factors in Renal Cell Carcinoma: Association of Preoperative Sodium Concentration with Survival

Preoperative Nomogram Predicting 12-Year Probability of Metastatic Renal Cancer

Waiting Time From Initial Urological Consultation to Nephrectomy for Renal Cell Carcinoma—Does it Affect Survival?

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