Survival following cytoreductive nephrectomy: a comparison of existing prognostic models

Abstract

Objective To validate models currently used to predict metastatic renal cell carcinoma (mRCC) outcomes in a cohort of patients undergoing cytoreductive nephrectomy (CN). Patients and methods A total of 10 RCC prognostic models (International Metastatic RCC Database Consortium [IMDC]; Memorial Sloan Kettering Cancer Center [MSKCC]; Culp; Leibovich; University of California at Los Angeles Integrated Staging System [UISS]; Stage, Size, Grade, and Necrosis [SSIGN]; Yaycioglu; Karakiewicz; Cindolo; and Margulis) were chosen based on clinical relevance and use in clinical trial design. Model validation was performed using patients who underwent CN at a single institution between 2005 and 2017, and model discrimination (ability to select patients at risk of death) was assessed. Concordance indices (c‐index) were calculated and compared with originally published c‐indices. Results A total of 515 CN patients were stratified according to the prognostic models. A total of 387 (75%) died over the study period, with estimated 3‐year survival of 46.1% (95% confidence interval [CI] 41.6–50.4%). All models’ discriminatory capacity underperformed when compared to the originally published c‐indices. The c‐indices ranged from 0.53 (95% CI 0.50–0.56) for the Cindolo model to 0.61 (95% CI 0.58–0.64) for the Leibovich model. The MSKCC and IMDC models performed poorly with c‐indices of 0.55 and 0.56, respectively. Conclusion Currently used prognostic models have limited discriminatory capacity when applied to a modern cohort of patients undergoing CN. They are inadequate for risk stratification and randomisation in prospective clinical trials of untreated patients with mRCC. Caution should be used when using these models for clinical decision making.

The roles of ferroptosis regulatory gene SLC7A11 in renal cell carcinoma: A multi‐omics study

“…A key study by Westerman et al found that commonly used 10 RCC prognostic models have limited discriminatory capacities and are inadequate for risk stratification. 47 Therefore, given that SLC7A11 was identified as an independent prognostic factor in RCC and was able to contribute to clinical benefit (Figure 3C-E), introducing SLC7A11 into the traditional prognostic model will improve its accuracy. In addition, patients with high SLC7A11 expression were prone to recurrence and progression (Figure 6H).…”

Circulating Non-coding RNAs in Renal Cell Carcinoma—Pathogenesis and Potential Implications as Clinical Biomarkers

“…Their respective prognoses for around 23% of patients in a treatment-naïve cohort undergoing the first line of targeted therapy do not match, suggesting limited prognostic capacity (Okita et al, 2019). They also do not perform well in predicting OS in patients undergoing cytoreductive nephrectomy (Westerman et al, 2020). Thus, implementation of additional or new biomarkers, to reliably stratify RCC patients in the era of targeted therapies, might be beneficial.…”

The impact of cytoreductive nephrectomy on survival outcomes in patients with metastatic renal cell carcinoma receiving immunotherapy: An evidence-based analysis of comparative outcomes

“…Patient selection is also a crucial consideration when evaluating the benefits of CN ( 41 ). As an invasive procedure for patients with high disease burden, CN carries a higher mortality risk than standard nephrectomy for T1 or T2 renal tumors ( 42 ).…”