Patients with renal cell carcinoma nodal metastases can be accurately identified: External validation of a new nomogram
Patients with renal cell carcinoma nodal metastases can be accurately identified: External validation of a new nomogram
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DOI：
10.1002/ijc.23010
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发表时间：
2007-12-01
影响因子：
6.4
通讯作者：
Karakiewicz, Pierre I.
中科院分区：
文献类型：
--
作者：
Hutterer, Georg C.;Patard, Jean-Jacques;Karakiewicz, Pierre I.
肾细胞癌淋巴结转移（NM）患者的预后明显比局部病变患者差。这证明对有 NM 风险或已确诊 NM 的患者进行更彻底的分期和可能更积极的治疗是合理的。我们开发并在外部验证了列线图，能够高度准确地预测没有远处转移的放射学证据的患者的肾细胞癌 NM。可获得 4,658 名个体的年龄、症状分类、肿瘤大小和病理淋巴结分期。来自 7 个中心的 2,522 名 (54.1%) 个体的数据被用来开发基于多变量逻辑回归模型的列线图，预测 NM 的个体概率。来自 5 个机构的 2,136 名患者（45.9%）的剩余数据用于外部验证。在开发队列中，107/2,522 (4.2%) 人出现淋巴结转移，而外部验证队列中则为 100/2,136 (4.7%)。在开发队列中，症状分类和肿瘤大小是 NM 的独立预测因素。年龄未能达到独立预测状态，但增加了模型的判别属性。基于年龄、症状分类和肿瘤大小的列线图在预测外部验证队列中 NM 个体概率时准确率为 78.4%。我们的列线图有助于识别 NM 低风险患者。该工具可以帮助风险调整没有已知远处转移的患者的淋巴结分期的需要和程度。更彻底的分期有望更好地选择那些需要辅助治疗的患者。 (C) 2007 Wiley-Liss, Inc.
Outcome of patients with renal cell carcinoma nodal metastases (NM) is substantially worse than that of patients with localized disease. This justifies more thorough staging and possibly more aggressive treatment in those at risk of or with established NM. We developed and externally validated a nomogram capable of highly accurately predicting renal cell carcinoma NM in patients without radiographic evidence of distant metastases. Age, symptom classification, tumour size and the pathological nodal stage were available for 4,658 individuals. The data of 2,522 (54.1 %) individuals from 7 centers were used to develop a multivariable logistic regression model-based nomogram predicting the individual probability of NM. The remaining data from 2,136 (45.9%) patients from 5 institutions were used for external validation. In the development cohort, 107/2,522 (4.2%) had lymph node metastases vs. 100/2,136 (4.7%) in the external validation cohort. Symptom classification and tumour size were independent predictors of NM in the development cohort. Age failed to reach independent predictor status, but added to discriminant properties of the model. A nomogram based on age, symptom classification and tumour size was 78.4% accurate in predicting the individual probability of NM in the external validation cohort. Our nomogram can contribute to the identification of patients at low risk of NM. This tool can help to risk adjust the need and the extent of nodal staging in patients without known distant metastases. More thorough staging can hopefully better select those in whom adjuvant treatment is necessary. (C) 2007 Wiley-Liss, Inc.