A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma
A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma
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DOI：
10.1097/01.ju.0000148261.19532.2c
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发表时间：
2005-01-01
影响因子：
6.6
通讯作者：
Russo, P
中科院分区：
文献类型：
--
作者：
Sorbellini, M;Kattan, MW;Russo, P
目的：很少有已发表的研究同时分析了多种预后因素，以预测传统的透明细胞肾皮质癌术后复发。为此，我们开发并执行了术后列线图的外部验证。我们使用了前瞻性更新的数据库中的1,400多名患者治疗在一个单一的institution.Materials和方法：从1989年1月至2002年8月，833肾切除术（部分和根治性）肾细胞癌的常规透明细胞组织学在纪念斯隆-凯特琳癌症中心进行了审查，从该中心的肾脏数据库。患有von Hippel-Lindau病或家族性综合征的患者，以及在手术前或手术时出现同步双侧肾脏肿块或远处转移或转移性区域淋巴结的患者被排除在研究之外。我们模拟了临床病理学。701例常规肾透明细胞癌患者的资料和疾病随访。诺模图的预后变量包括病理分期，Fuhrman分级，肿瘤大小，坏死，血管浸润和临床表现（即偶然无症状，局部症状或全身症状）。那些没有疾病证据的患者的中位和最长随访时间分别为32个月和120个月。患者队列的5年无复发概率为80.9%（95%置信区间为75.7%至85.1%）。基于考克斯比例风险回归模型设计列线图。经外部验证后，诺模图预测结果准确，一致性指数为0.82。结论：本研究建立的诺模图可用于预测肾透明细胞癌患者5年无复发概率。此列线图可用于患者咨询、临床试验设计和有效的患者随访策略。
Purpose: Few published studies have simultaneously analyzed multiple prognostic factors to predict recurrence after surgery for conventional clear cell renal cortical carcinomas. We developed and performed external validation of a postoperative nomogram for this purpose. We used a prospectively updated database of more than 1,400 patients treated at a single institution.Materials and Methods: From January 1989 to August 2002, 833 nephrectomies (partial and radical) for renal cell carcinoma of conventional clear cell histology performed at Memorial Sloan-Kettering Cancer Center were reviewed from the center's kidney database. Patients with von Hippel-Lindau disease or familial syndromes, as well as patients presenting with synchronous bilateral renal masses, or distant metastases or metastatic regional lymph nodes before or at surgery were excluded from study. We modeled clinicopathological. data and disease followup for 701 patients with conventional clear cell renal cell carcinoma. Prognostic variables for the nomogram included pathological stage, Fuhrman grade, tumor size, necrosis, vascular invasion and clinical presentation (ie incidental asymptomatic, locally symptomatic or systemically symptomatic).Results: Disease recurrence was noted in 72 of 701 patients. Those patients without evidence of disease had a median and maximum followup, of 32 and 120 months, respectively. The 5-year probability of freedom from recurrence for the patient cohort was 80.9% (95% confidence interval 75.7% to 85.1%). A nomogram was designed based on a Cox proportional hazards regression model. Following external validation predictions by the nomogram appeared accurate and discriminating, and the concordance index was 0.82.Conclusions: A nomogram has been developed that can be used to predict the 5-year probability of freedom from recurrence for patients with conventional clear cell renal cell carcinoma. This nomogram may be useful for patient counseling, clinical trial design and effective patient followup strategies.