Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy -: A multicenter European study
Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy -: A multicenter European study
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DOI：
10.1002/cncr.21331
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发表时间：
2005-10-01
期刊：
影响因子：
6.2
通讯作者：
Gallo, C
中科院分区：
文献类型：
--
作者：
Cindolo, L;Patard, JJ;Gallo, C
背景本研究的目的是在一项大型多中心研究中比较四种预测非转移性肾细胞癌（RCC）患者行肾切除术后生存率的预后模型的判别准确性。对来自6个欧洲中心的2404例患者记录进行了回顾性分析。对于每个患者，根据四种模型计算预后评分：Kestival模型、加州大学洛杉矶分校综合分期系统（UISS）模型、Yaycioglu模型和Cindolo模型。采用Kaplan-Meier法估计生存曲线，并采用对数秩检验进行比较。对删失数据采用Harrell c指数评价判别能力。主要终点为总生存期（OS），次要终点为癌症特异性生存期（CSS）和无疾病复发生存期（RFS）。末次随访时，541例受试者死于任何原因，5年OS率为80%。5年CSS和RFS率分别为85%和78%。所有模型均具有良好的区分性（P < 0.0001）。OS的c指数分别为0.706（Kynomogram）、0.683（UISS模型）、0.589（Yaycioglu模型）和0.615（Cindolo模型）。发现Kynomogram显著提高了UISS中危患者的辨别力。目前的研究似乎更好地定义了预测非转移性肾细胞癌患者肾切除术后生存率的预后模型的普遍适用性。结果表明，术后模型的区别明显优于术前。一直以来，人们都认为Kendall模型是最准确的，尽管UISS模型的表现略差。KISS模型可用于UISS中危患者。
BACKGROUND. The objective of the current study was to compare, in a large multicenter study, the discriminating accuracy of four prognostic models developed to predict the survival of patients undergoing nephrectomy for nonmetastatic renal cell carcinoma (RCC).METHODS. A total of 2404 records of patients from 6 European centers were retrospectively reviewed. For each patient, prognostic scores were calculated according to four models: the Kattan model, the University of California at Los Angeles integrated staging system (UISS) model, the Yaycioglu model, and the Cindolo model. Survival curves were estimated by the Kaplan-Meier method and compared by the log-rank test. Discriminating ability was assessed by the Harrell c-index for censored data. The primary end point was overall survival (OS), and the secondary end points were cancer-specific survival (CSS) and disease recurrence-free survival (RFS).RESULTS. At last follow-up, 541 subjects had died of any causes, with a 5-year OS rate of 80%. The 5-year CSS and RFS rates were 85% and 78%, respectively. All models discriminated well (P < 0.0001). The c-indexes for OS were 0.706 for the Kattan nomogram, 0.683 for the UISS model, and 0.589 and 0.615 for the Yaycioglu and Cindolo models, respectively. The Kattan nomogram was found to improve discrimination substantially in the UISS intermediate-risk patients.CONCLUSIONS. The current study appears to better define the general applicability of prognostic models for predicting survival in patients with nonmetastatic RCC treated with nephrectomy. The results suggest that postoperative models discriminate substantially better than preoperative ones. The Kattan model was consistently found to be the most accurate, although the UISS model was only slightly less well performing. The Kattan model can be useful in the UISS intermediate -risk patients.