The Karakiewicz nomogram is the most useful clinical predictor for survival outcomes in patients with localized renal cell carcinoma
The Karakiewicz nomogram is the most useful clinical predictor for survival outcomes in patients with localized renal cell carcinoma
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DOI：
10.1002/cncr.26193
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发表时间：
2011-12-01
期刊：
影响因子：
6.2
通讯作者：
Cheng, Christopher
中科院分区：
文献类型：
--
作者：
Tan, Min-Han;Li, Huihua;Cheng, Christopher
背景：手术切除局限性肾细胞癌（RCC）后的结果是可变的。已经开发了多个预后列线图和风险组用于估计生存结局，不同的模型用于评估正在进行的辅助治疗试验中的患者资格。作者的目的是为局部RCC患者建立最有用的预后模型，以指导试验设计，生物标志物研究和临床咨询。方法：回顾性评价了一家三级医院（1990-2006年）中位随访65个月的390例因散发性局部RCC接受肾切除术的连续患者。比较Karakiewicz诺模图、Kynomogram诺模图、Sorbellini诺模图和Leibovich模型在使用似然分析、充分性指数、决策曲线分析、校准和一致性指数预测生存结局（总生存期、癌症特异性生存期和无复发率）方面的作用。结果：总体而言，Karakiewicz诺模图优于Kynomogram诺模图、Sorbellini诺模图和Leibovich模型。在生存预测中使用Karakiewicz列线图，在双变量模型（包括竞争性预后模型）中使用似然比分析，可以看到高度提高的准确性。Karakiewicz列线图显示了更高的充分性和一致性指数，并改善了临床获益相对于所有其他列线图。所有4个模型均经过合理校准。预先设定的离散化Karakiewicz列线图和SORCE试验招募标准（离散化Leibovich模型）的高风险患者的探索性比较有利于离散化Karakiewicz列线图。结论：Karakiewicz列线图在预测局部RCC的生存结局方面显示出上级于其他测试列线图和风险组。应考虑将该模型常规整合到试验设计和生物标志物研究中。Cancer 2011; 117：5314-24. (C)2011年美国癌症协会
BACKGROUND: Outcomes after surgical removal of localized renal cell carcinoma (RCC) are variable. There have been multiple prognostic nomograms and risk groups developed for estimation of survival outcomes, with different models in use for evaluating patient eligibility in ongoing trials of adjuvant therapy. The authors aimed to establish the most useful prognostic model for patients with localized RCC to guide trial design, biomarker research, and clinical counseling. METHODS: A total of 390 consecutive patients who underwent nephrectomy for sporadic localized RCC in a tertiary institution (1990-2006) with 65 months median follow-up were retrospectively evaluated. The Karakiewicz nomogram, the Kattan nomogram, the Sorbellini nomogram, and the Leibovich model were compared in predicting survival outcomes (overall survival, cancer-specific survival, and freedom from recurrence) using likelihood analysis, adequacy indices, decision curve analysis, calibration, and concordance indices. RESULTS: Overall, the Karakiewicz nomogram outperformed the Kattan nomogram, the Sorbellini nomogram, and the Leibovich model. Highly improved accuracy was seen using the Karakiewicz nomogram in survival prediction, using likelihood ratio analysis in bivariate models including the competing prognostic models. The Karakiewicz nomogram showed higher adequacy and concordance indices and improved clinical benefit relative to all other nomograms. All 4 models were reasonably calibrated. Exploratory comparisons of prespecified discretized Karakiewicz nomograms and the SORCE trial recruitment criteria (a discretized Leibovich model) of high-risk patients favored the discretized Karakiewicz nomograms. CONCLUSIONS: The Karakiewicz nomogram was shown to be superior to the other tested nomograms and risk groups in predicting survival outcomes in localized RCC. Routine integration of this model into trial design and bio-marker research should be considered. Cancer 2011; 117: 5314-24. (C) 2011 American Cancer Society.