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dc.contributor.authorMarconi, Lorenzo
dc.contributor.authorde Bruijn, Roderick
dc.contributor.authorvan Werkhoven, Erik
dc.contributor.authorBeisland, Christian
dc.contributor.authorFife, Kate
dc.contributor.authorHeidenreich, Axel
dc.contributor.authorKapoor, Anil
dc.contributor.authorKaram, Jose
dc.contributor.authorKauffmann, Caroline
dc.contributor.authorKlatte, Tobias
dc.contributor.authorLjungberg, Boerje
dc.contributor.authorMatin, Surena
dc.contributor.authorSjoberg, Daniel
dc.contributor.authorStaehler, Michael
dc.contributor.authorStewart, Grant
dc.contributor.authorTanguay, Simon
dc.contributor.authorUzzo, Robert
dc.contributor.authorWelsh, Sarah
dc.contributor.authorWood, Lori
dc.contributor.authorWood, Chris
dc.contributor.authorBex, Axel
dc.date.accessioned2018-09-08T06:33:40Z
dc.date.available2018-09-08T06:33:40Z
dc.date.issued2018-12
dc.identifier.issn0724-4983
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/279888
dc.description.abstractINTRODUCTION: 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.
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherSpringer Science and Business Media LLC
dc.subjectHumans
dc.subjectCarcinoma, Renal Cell
dc.subjectBone Neoplasms
dc.subjectLiver Neoplasms
dc.subjectAdrenal Gland Neoplasms
dc.subjectBrain Neoplasms
dc.subjectLung Neoplasms
dc.subjectKidney Neoplasms
dc.subjectNeoplasm Metastasis
dc.subjectL-Lactate Dehydrogenase
dc.subjectSerum Albumin
dc.subjectAntineoplastic Agents
dc.subjectNeoplasm Staging
dc.subjectPrognosis
dc.subjectBlood Transfusion
dc.subjectIntraoperative Care
dc.subjectNephrectomy
dc.subjectSurvival Rate
dc.subjectArea Under Curve
dc.subjectNomograms
dc.subjectReproducibility of Results
dc.subjectPatient Selection
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.subjectKaplan-Meier Estimate
dc.subjectMolecular Targeted Therapy
dc.subjectCytoreduction Surgical Procedures
dc.titleExternal validation of a predictive model of survival after cytoreductive nephrectomy for metastatic renal cell carcinoma.
dc.typeArticle
prism.endingPage1980
prism.issueIdentifier12
prism.publicationDate2018
prism.publicationNameWorld J Urol
prism.startingPage1973
prism.volume36
dc.identifier.doi10.17863/CAM.27256
dcterms.dateAccepted2018-07-28
rioxxterms.versionofrecord10.1007/s00345-018-2427-z
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-12
dc.contributor.orcidStewart, Grant [0000-0003-3188-9140]
dc.contributor.orcidWelsh, Sarah [0000-0001-5690-2677]
dc.identifier.eissn1433-8726
rioxxterms.typeJournal Article/Review
cam.issuedOnline2018-08-01
rioxxterms.freetoread.startdate2019-08-31


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