TY - JOUR
T1 - Assessing the accuracy and generalizability of the preoperative and postoperative Karakiewicz nomograms for renal cell carcinoma
T2 - Results from a multicentre European and US study
AU - Cindolo, Luca
AU - Chiodini, Paolo
AU - Brookman-May, Sabine
AU - De Cobelli, Ottavio
AU - May, Matthias
AU - Squillacciotti, Stefano
AU - De Nunzio, Cosimo
AU - Tubaro, Andrea
AU - Coman, Ioan
AU - Feciche, Bodgan
AU - Truss, Michael
AU - Wirth, Manfred P.
AU - Dalpiaz, Orietta
AU - Chromecki, Thomas F.
AU - Shariat, Shahrock F.
AU - Sanchez-Chapado, Manuel
AU - Del Carmen Santiago Martin, Maria
AU - Rocco, Bernardo
AU - Salzano, Luigi
AU - Lotrecchiano, Giuseppe
AU - Berardinelli, Francesco
AU - Schips, Luigi
PY - 2013/9
Y1 - 2013/9
N2 - Objective 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). Patients and Methods 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. Results 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. Conclusions 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.
AB - Objective 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). Patients and Methods 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. Results 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. Conclusions 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.
KW - cancer-specific survival
KW - prognosis
KW - renal cell carcinoma
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U2 - 10.1111/j.1464-410X.2012.11670.x
DO - 10.1111/j.1464-410X.2012.11670.x
M3 - Article
C2 - 23470199
AN - SCOPUS:84882267677
VL - 112
SP - 578
EP - 584
JO - BJU International
JF - BJU International
SN - 1464-4096
IS - 5
ER -