A postoperative prognostic nomogram for renal cell carcinoma
A postoperative prognostic nomogram for renal cell carcinoma
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DOI：
10.1016/s0022-5347(05)66077-6
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发表时间：
2001-07-01
影响因子：
6.6
通讯作者：
Russo, P
中科院分区：
文献类型：
--
作者：
Kattan, MW;Reuter, V;Russo, P
目的：很少有已发表的研究结合预后因素预测肾细胞癌术后复发的可能性。为了这个目的，我们开发了一种图解法。材料与方法：采用Cox比例风险回归分析，对601例行肾切除术的肾细胞癌患者的病理资料和疾病随访进行建模。预测变量为患者症状，包括偶发、局部或全身性，组织学，包括恐色、乳头状或常规，肿瘤大小和病理分期。当有疾病复发或疾病死亡的临床证据时，记录治疗失败。使用统计（自举）技术执行验证。结果：601例患者中66例出现疾病复发，治疗成功的患者中位随访时间为40个月，最长随访时间为123个月。患者队列免于失败的5年概率为86%（95%置信区间82 - 89）。经统计验证，nomogram预测结果是准确的，且与受试者工作特征曲线下的面积有一定的区别，即预测概率与实际结果的比较为0.74。结论：已开发出一种可用于预测新诊断肾细胞癌患者5年治疗失败概率的图。该图可能对患者咨询、临床试验设计和患者随访计划有用。
Purpose: Few published studies have combined prognostic factors to predict the likelihood of recurrence after surgery for renal cell carcinoma. We developed a nomogram for this purpose.Materials and Methods: With Cox proportional hazards regression analysis, we modeled pathological data and disease followup for 601 patients with renal cell carcinoma who were treated with nephrectomy. Predictor variables were patient symptoms, including incidental, local or systemic, histology, including chromophobe, papillary or conventional, tumor size, and pathological stage. Treatment failure was recorded when there was either clinical evidence of disease recurrence or death from disease. Validation was performed with a statistical (bootstrapping) technique.Results: Disease recurrence was noted in 66 of the 601 patients, and those in whom treatment was successful had a median and maximum followup of 40 and 123 months, respectively. The 5-year probability of freedom from failure for the patient cohort was 86% (95% confidence interval 82 to 89). With statistical validation, predictions by the nomogram appeared accurate and discriminating with an area under the receiver operating characteristic curve, that is a comparison of the predicted probability with the actual outcome of 0.74.Conclusions: A nomogram has been developed that can be used to predict the 5-year probability of treatment failure among patients with newly diagnosed renal cell carcinoma. The nomogram may be useful for patient counseling, clinical trial design and patient followup planning.