Platinum Priority – Kidney CancerEditorial by Christian Bolenz and Yair Lotan on pp. 296–298 of this issueA Preoperative Prognostic Model for Patients Treated with Nephrectomy for Renal Cell Carcinoma
Introduction
Currently, two pretreatment prognostic models address the natural history of treated renal cell carcinoma (RCC) [1], [2]. Both predict disease recurrence after nephrectomy. Unfortunately, both are limited by relatively low accuracy (65% and 67%), which undermines the usefulness of their predictions [1], [2]. Moreover, both are limited to predictions in patients with localized RCC. To circumvent the limitations related to stage and accuracy and to address mortality, which represents a more definitive end point, we developed and internally validated a pretreatment nomogram predicting freedom from RCC-specific mortality using data from a large multi-institutional cohort. Subsequently, we used an independent validation cohort to test the accuracy of this pretreatment nomogram.
Section snippets
Study cohort
Five participating institutions contributed data from a total of 2485 patients at various stages of RCC between 1984 and 2006; this constituted the nomogram development cohort. Data from an additional 1978 patients from seven institutions were included in the external validation cohort. All patients were treated with either open radical or partial nephrectomy. All preoperative data were prospectively gathered at each center. Patient age, gender, clinical stage, presence of metastases, tumor
Results
The descriptive statistics of the nomogram development and the external validation cohorts are listed in Table 1. Within the development cohort, 650 patients (26.3%) and 565 patients (22.8%) had tumors classified as T1a and T1b. Tumor size ranged from 0.5 cm to 25 cm (mean, 6.6 cm). Metastatic disease at presentation was present in 295 patients (11.9%). Local symptoms were present in 897 patients (35.5%) versus systemic symptoms present in 453 patients (18.3%). Table 1 demonstrates minor
Discussion
Over the past 2 decades, the management options for patients with RCC of all stages have increased exponentially [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]. Despite the abundance of treatment modalities, only two prognostic models are available to assist clinicians and patients with treatment choices before therapy is determined. Both models are limited to patients with clinically localized (T1 or T2) disease [1], [2] and provide very limited accuracy (65% and
Conclusions
The current nomogram represents the most contemporary and the most accurate pretreatment prognostic model for prediction of RCC-specific mortality from 1 yr to 10 yr after nephrectomy. Its predictions may be used to provide a framework for comparisons between nephrectomy and alternative treatment modalities for all stages of RCC.
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