Assessing the accuracy and generalizability of the preoperative and postoperative Karakiewicz nomograms for renal cell carcinoma: results from a multicentre European and US study. Academic Article Article uri icon

Overview

MeSH

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Calibration
  • Disease-Free Survival
  • Europe
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nephrectomy
  • Odds Ratio
  • Postoperative Period
  • Predictive Value of Tests
  • Preoperative Period
  • Prognosis
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Assessment
  • Time Factors
  • United States

MeSH Major

  • Carcinoma, Renal Cell
  • Kidney Neoplasms
  • Nomograms

abstract

  • To assess the accuracy and generalizability of the pre- and postoperative Karakiewicz nomograms for predicting cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC). This retrospective study included 3231 patients from European and US centres, who were treated by radical or partial nephrectomy for RCC between 1992 and 2010. Prognostic scores for each patient were calculated and the primary endpoint was CSS. Discriminating ability was assessed by Harrell's c-index for censored data. The 'validation by calibration' method proposed by Van Houwelingen was used for checking the calibration of covariate effects. Calibration was graphically explored. Local and systemic symptoms were present in 23.2% and 9.1% of the patients, respectively. The median follow-up (FU) was 49 months. At the last FU, 408 cancer-related deaths were recorded, Kaplan-Meier estimates of CSS (with 95% confidence intervals [CIs]) at 5 and 10 years were 0.86 (0.84-0.87) and 0.77 (0.75-0.80), respectively. Both nomograms discriminated well. Stratified c-indices for CSS were 0.784 (95% CI 0.753-0.814) for the preoperative nomogram, and 0.842 (95% CI 0.816-0.867) for the postoperative one, with a significant difference between the two values (P < 0.001). The covariate-based predictions on our data for both nomograms were valid. The calibration plots showed no relevant departures from ideal predictions. The results suggest that the postoperative Karakiewicz nomogram discriminates substantially better than the preoperative one. These nomogram-based predictions may be used as benchmark data for pretreatment and postoperative decision-making in patients at various stages of RCC. © 2013 BJU International.

publication date

  • September 2013

has subject area

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Calibration
  • Carcinoma, Renal Cell
  • Disease-Free Survival
  • Europe
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Neoplasms
  • Male
  • Middle Aged
  • Nephrectomy
  • Nomograms
  • Odds Ratio
  • Postoperative Period
  • Predictive Value of Tests
  • Preoperative Period
  • Prognosis
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Assessment
  • Time Factors
  • United States

Research

keywords

  • Journal Article
  • Multicenter Study
  • Validation Studies

Identity

Language

  • eng

Digital Object Identifier (DOI)

  • 10.1111/j.1464-410X.2012.11670.x

PubMed ID

  • 23470199

Additional Document Info

start page

  • 578

end page

  • 584

volume

  • 112

number

  • 5