External validation of a predictive model of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma.
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Authors
Marconi, Lorenzo
de Bruijn, Roderick
van Werkhoven, Erik
Beisland, Christian
Fife, Kate
Heidenreich, Axel
Kapoor, Anil
Karam, Jose
Kauffmann, Caroline
Klatte, Tobias
Ljungberg, Boerje
Matin, Surena
Sjoberg, Daniel
Staehler, Michael
Stewart, Grant D
Tanguay, Simon
Uzzo, Robert
Wood, Lori
Wood, Chris
Bex, Axel
Publication Date
2018-12Journal Title
World J Urol
ISSN
0724-4983
Publisher
Springer Science and Business Media LLC
Volume
36
Issue
12
Pages
1973-1980
Language
eng
Type
Article
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Marconi, L., de Bruijn, R., van Werkhoven, E., Beisland, C., Fife, K., Heidenreich, A., Kapoor, A., et al. (2018). External validation of a predictive model of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma.. World J Urol, 36 (12), 1973-1980. https://doi.org/10.1007/s00345-018-2427-z
Abstract
INTRODUCTION: Recent trials have emphasized the importance of a precise patient selection for cytoreductive nephrectomy (CN). In 2013, a nomogram was developed for pre- and postoperative prediction of the probability of death (PoD) after CN in patients with metastatic renal cell carcinoma. To date, the single-institutional nomogram which included mostly patients from the cytokine era has not been externally validated. Our objective is to validate the predictive model in contemporary patients in the targeted therapy era. METHODS: Multi-institutional European and North American data from patients who underwent CN between 2006 and 2013 were used for external validation. Variables evaluated included preoperative serum albumin and lactate dehydrogenase levels, intraoperative blood transfusions (yes/no) and postoperative pathologic stage (primary tumour and nodes). In addition, patient characteristics and MSKCC risk factors were collected. Using the original calibration indices and quantiles of the distribution of predictions, Kaplan-Meier estimates and calibration plots of observed versus predicted PoD were calculated. For the preoperative model a decision curve analysis (DCA) was performed. RESULTS: Of 1108 patients [median OS of 27 months (95% CI 24.6-29.4)], 536 and 469 patients had full data for the validation of the pre- and postoperative models, respectively. The AUC for the pre- and postoperative model was 0.68 (95% CI 0.62-0.74) and 0.73 (95% CI 0.68-0.78), respectively. In the DCA the preoperative model performs well within threshold survival probabilities of 20-50%. Most important limitation was the retrospective collection of this external validation dataset. CONCLUSIONS: In this external validation, the pre- and postoperative nomograms predicting PoD following CN were well calibrated. Although performance of the preoperative nomogram was lower than in the internal validation, it retains the ability to predict early death after CN.
Keywords
Cytoreductive nephrectomy, Metastatic renal cancer, Nomogram, Selection, Targeted therapy, Validation, Adrenal Gland Neoplasms, Aged, Antineoplastic Agents, Area Under Curve, Blood Transfusion, Bone Neoplasms, Brain Neoplasms, Carcinoma, Renal Cell, Cytoreduction Surgical Procedures, Female, Humans, Intraoperative Care, Kaplan-Meier Estimate, Kidney Neoplasms, L-Lactate Dehydrogenase, Liver Neoplasms, Lung Neoplasms, Male, Middle Aged, Molecular Targeted Therapy, Neoplasm Metastasis, Neoplasm Staging, Nephrectomy, Nomograms, Patient Selection, Prognosis, Reproducibility of Results, Serum Albumin, Survival Rate
Identifiers
External DOI: https://doi.org/10.1007/s00345-018-2427-z
This record's URL: https://www.repository.cam.ac.uk/handle/1810/279888
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