Evaluating Overall Survival and Competing Risks of Death in Patients With Localized Renal Cell Carcinoma Using a Comprehensive Nomogram
Evaluating Overall Survival and Competing Risks of Death in Patients With Localized Renal Cell Carcinoma Using a Comprehensive Nomogram
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DOI：
10.1200/jco.2009.22.4816
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发表时间：
2010-01-10
影响因子：
45.3
通讯作者：
Uzzo, Robert G.
中科院分区：
文献类型：
--
作者：
Kutikov, Alexander;Egleston, Brian L.;Uzzo, Robert G.
目的：许多局限性淋巴结阴性肾细胞癌（RCC）患者是老年人，存在竞争性合并症。手术治疗后的总体生存率尚不清楚。我们回顾了监测，流行病学和最终结果（SEER）数据库中的病例，以评估肾癌与竞争性死亡原因对局部RCC患者的影响，并建立一个全面的列线图来定量生存差异。MethodsWe确定了个体局部化，手术治疗透明细胞，乳头状或嫌色RCC SEER（1988年至2003年）。我们使用精细和灰色的竞争风险比例风险回归预测5年的概率三个竞争死亡率的结果：肾癌死亡，其他癌症死亡，和noncancer death.ResultsWe确定了30,801例局部RCC（中位年龄，62岁;中位肿瘤大小，4.5厘米）。肾癌死亡、其他癌症死亡和非癌症死亡的五年概率分别为4%、7%和11%。年龄对死亡率有很强的预测作用，对非肾癌死亡的预测作用最大（P <0.001）。肿瘤大小的增加与肾细胞癌的死亡相关，与非癌死亡呈负相关（P <0.001）。结果的种族差异在非肾癌死亡中最为明显（P <0.001）。男性比女性更容易死于各种原因（P <0.002）。这个列线图集成了常用的因素，成为一个有用的工具，比较竞争的死亡risks of death.ConclusionManagement本地化RCC必须考虑竞争的死亡原因，特别是在老年人群。有效的决策需要进行治疗权衡计算。我们提出了一个工具，以定量竞争的死亡原因在局部肾细胞癌患者。
PurposeMany patients with localized node-negative renal cell carcinoma (RCC) are elderly with competing comorbidities. Their overall survival benefit after surgical treatment is unknown. We reviewed cases in the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the impact of kidney cancer versus competing causes of death in patients with localized RCC and develop a comprehensive nomogram to quantitate survival differences.MethodsWe identified individuals with localized, surgically treated clear-cell, papillary, or chromophobe RCC in SEER (1988 through 2003). We used Fine and Gray competing risks proportional hazards regressions to predict 5-year probabilities of three competing mortality outcomes: kidney cancer death, other cancer death, and noncancer death.ResultsWe identified 30,801 cases of localized RCC (median age, 62 years; median tumor size, 4.5 cm). Five-year probabilities of kidney cancer death, other cancer death, and noncancer death were 4%, 7%, and 11%, respectively. Age was strongly predictive of mortality and most predictive of nonkidney cancer deaths (P < .001). Increasing tumor size was related to death from RCC and inversely related to noncancer deaths (P < .001). Racial differences in outcomes were most pronounced for nonkidney cancer deaths (P < .001). Men were more likely to die than women from all causes (P < .002). This nomogram integrates commonly available factors into a useful tool for comparing competing risks of death.ConclusionManagement of localized RCC must consider competing causes of mortality, particularly in elderly populations. Effective decision making requires treatment trade-off calculations. We present a tool to quantitate competing causes of mortality in patients with localized RCC.