Preoperative Prognostic Nomogram (Probability Table) for Renal Cell Carcinoma Based on TNM Classification
Preoperative Prognostic Nomogram (Probability Table) for Renal Cell Carcinoma Based on TNM Classification
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DOI：
10.1016/j.juro.2008.10.017
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发表时间：
2009-02-01
影响因子：
6.6
通讯作者：
Oya, Mototsugu
中科院分区：
文献类型：
--
作者：
Kanao, Kent;Mizuno, Ryuichi;Oya, Mototsugu
目的：最近开发了几种预后列线图来预测恶性疾病的预后，包括肾细胞癌。然而，据我们所知，尚无预测肾细胞癌患者生存的术前预后列线图。我们根据 TNM 分类开发了术前列线图，可预测肾细胞癌患者的病因特异性生存率。 材料和方法：本研究纳入了 545 例在我们机构接受根治性肾切除术或肾单位保留手术的肾细胞癌（包括转移性疾病）患者。病例按照2002年UICC TNM系统第6版进行分级。 T、N 和 M 因素被用作预后因素，并开发了 Cox 比例风险回归模型来预测原因特异性生存。通过对 200 个 bootstrap 样本进行重复分析，开发了预测特定原因生存率的列线图。为了验证列线图，估计了一致性指数，并通过绘制列线图的预测来检查校准。结果：患者总体 1 年、3 年和 5 年生存率分别为 95.2%、92.0% 和 89.9%。 T、N 和 M 因素是 Cox 比例风险回归模型中的重要预后因素。利用综合的 TNM 因素，我们开发了一个列线图来预测 1 年、3 年和 5 年的特定原因生存率。该列线图具有出色的区分能力，一致性指数为 0.81，并且总体校准良好。结论：该列线图显示的术前信息对于获得有手术指征的肾细胞癌患者的知情同意可能很重要。
Purpose: Recently several prognostic nomograms have been developed to predict the prognosis of malignant diseases, including renal cell carcinoma. However, to our knowledge a preoperative prognostic nomogram that predicts survival in patients with renal cell carcinoma is not available. We developed a preoperative nomogram based on the TNM classification that predicts cause specific survival in patients with renal cell carcinoma.Materials and Methods: A total of 545 patients with renal cell carcinoma, including metastatic disease, who underwent radical nephrectomy or nephron sparing surgery at our institution were included in the study. Cases were staged according to the 2002 UICC TNM system, 6th edition. T, N and M factors were used as prognostic factors and a Cox proportional hazards regression model was developed to predict cause specific survival. A nomogram to predict cause specific survival was developed by repeating the analysis on 200 bootstrap samples. To validate the nomogram a concordance index was estimated and calibration was also examined by plotting the predictions made by the nomogram.Results: Overall 1, 3 and 5-year patient survival was 95.2%, 92.0% and 89.9%, respectively. T, N and M factors were significant prognostic factors in the Cox proportional hazards regression model. Using the combined TNM factors we developed a nomogram predicting 1., 3 and 5-year cause specific survival rates. The nomogram had excellent ability to discriminate, as evidenced by a concordance index of 0.81, and it was generally well calibrated.Conclusions: The preoperative information shown by this nomogram may be important for obtaining informed consent, from patients with renal cell carcinoma who have indications for surgery.