Risk models for recurrence and survival after kidney cancer: a systematic review.

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OBJECTIVE: To systematically identify and compare the performance of prognostic models providing estimates of survival or recurrence of localized renal cell cancer (RCC) in patients treated with surgery with curative intent. MATERIALS AND METHODS: We performed a systematic review (PROSPERO CRD42019162349). We searched Medline, EMBASE and the Cochrane Library from 1 January 2000 to 12 December 2019 to identify studies reporting the performance of one or more prognostic model(s) that predict recurrence-free survival (RFS), cancer-specific survival (CSS) or overall survival (OS) in patients who have undergone surgical resection for localized RCC. For each outcome we summarized the discrimination of each model using the C-statistic and performed multivariate random-effects meta-analysis of the logit transformed C-statistic to rank the models. RESULTS: Of a total of 13 549 articles, 57 included data on the performance of 22 models in external populations. C-statistics ranged from 0.59 to 0.90. Several risk models were assessed in two or more external populations and had similarly high discriminative performance. For RFS, these were the Sorbellini, Karakiewicz, Leibovich and Kattan models, with the UCLA Integrated Staging System model also having similar performance in European/US populations. All had C-statistics ≥0.75 in at least half of the validations. For CSS, they the models with the highest discriminative performance in two or more external validation studies were the Zisman, Stage, Size, Grade and Necrosis (SSIGN), Karakiewicz, Leibovich and Sorbellini models (C-statistic ≥0.80 in at least half of the validations), and for OS they were the Leibovich, Karakiewicz, Sorbellini and SSIGN models. For all outcomes, the models based on clinical features at presentation alone (Cindolo and Yaycioglu) had consistently lower discrimination. Estimates of model calibration were only infrequently included but most underestimated survival. CONCLUSION: Several models had good discriminative ability, with there being no single 'best' model. The choice from these models for each setting should be informed by both the comparative performance and availability of factors included in the models. All would need recalibration if used to provide absolute survival estimates.

#KidneyCancer, #kcsm, #uroonc, prognosis, recurrence, renal cell cancer, risk prediction, survival, Humans, Carcinoma, Renal Cell, Kidney Neoplasms, Prognosis
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Cancer Research UK (21464)
Cancer Research UK (C96/A25177)
MRC (MC_UU_00006/6)
National Institute for Health and Care Research (IS-BRC-1215-20014)
Medical Research Council (MC_UU_12015/4)
JUS was funded by a Cancer Research UK Prevention Fellowship (C55650/A21464). The University of Cambridge has received salary support in respect of SJG from the NHS in the East of England through the Clinical Academic Reserve. SHR is funded by a Cancer Research UK Clinical PhD Fellowship. GDS is supported by the Renal Cancer Research Fund, The Mark Foundation for Cancer Research, the Cancer Research UK Cambridge Centre [C9685/A25177] and NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. HH was supported by a National Institute of Health Research Methods Fellowship (RM-SR-2017-09-009) and is now supported by a National Institute of Health Research Development and Skills Enhancement Award (NIHR301182). SJS is funded by the Medical Research Council (MC_UU_00006/6).