Multi-institutional validation of a new renal cancer-specific survival nomogram
Multi-institutional validation of a new renal cancer-specific survival nomogram
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DOI：
10.1200/jco.2006.06.1218
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发表时间：
2007-04-10
影响因子：
45.3
通讯作者：
Patard, Jean-Jacques
中科院分区：
文献类型：
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作者：
Karakiewicz, Pierre I.;Briganti, Alberto;Patard, Jean-Jacques
目的我们测试了这样的假设：如果在预后列线图中使用传统的预测变量，则可以改善肾癌特异性生存的预测。患者和方法使用了两组因肾皮质肿瘤接受根治性或部分肾切除术治疗的患者：一组 (n = 2,530) 用于列线图开发和内部验证（200 个引导程序重新采样），第二组 (n = 1,422）用于外部验证。 Cox 比例风险回归分析对 2002 年 TNM 分期、肿瘤大小、Fuhrman 分级、组织学亚型、局部症状、年龄和性别进行了建模。将列线图的准确性与已建立的分期方案进行比较。结果在 598 名患者 (23.6%) 中观察到癌症特异性死亡率，而 200 名患者 (7.9%) 因其他原因死亡。随访时间为 0.1 至 286 个月（中位数为 38.8 个月）。肾切除术后 1 年、2 年、5 年和 10 年列线图的外部验证显示预测准确度分别为 87.8%、89.2%、86.7% 和 88.8%。相反，预测 2 年和 5 年的替代分期方案不太准确，估计值为 86.1% ( P = .006) 和 83.9% ( P = .02)。 结论 新列线图更加现代，提供了更及时的预测，并且与预测 2 年和 5 年的替代分期方案相比，预测准确率分别提高了 3.1% 和 2.8%。
PurposeWe tested the hypothesis that the prediction of renal cancer - specific survival can be improved if traditional predictor variables are used within a prognostic nomogram.Patients and MethodsTwo cohorts of patients treated with either radical or partial nephrectomy for renal cortical tumors were used: one ( n = 2,530) for nomogram development and for internal validation ( 200 bootstrap resamples), and a second ( n = 1,422) for external validation. Cox proportional hazards regression analyses modeled the 2002 TNM stages, tumor size, Fuhrman grade, histologic subtype, local symptoms, age, and sex. The accuracy of the nomogram was compared with an established staging scheme.ResultsCancer-specific mortality was observed in 598 (23.6%) patients, whereas 200 (7.9%) died as a result of other causes. Follow-up ranged from 0.1 to 286 months ( median, 38.8 months). External validation of the nomogram at 1, 2, 5, and 10 years after nephrectomy revealed predictive accuracy of 87.8%, 89.2%, 86.7%, and 88.8%, respectively. Conversely, the alternative staging scheme predicting at 2 and 5 years was less accurate, as evidenced by 86.1% ( P =.006) and 83.9% ( P =.02) estimates.ConclusionThe new nomogram is more contemporary, provides predictions that reach further in time and, compared with its alternative, which predicts at 2 and 5 years, generates 3.1% and 2.8% more accurate predictions, respectively.