1659 QUANTIFICATION OF COMPETING RISKS OF DEATH IN PATIENTS WITH LOCALIZED RENAL CELL CARCINOMA (RCC): A COMPREHENSIVE NOMOGRAM INCORPORATING CO-MORBIDITIES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111659 QUANTIFICATION OF COMPETING RISKS OF DEATH IN PATIENTS WITH LOCALIZED RENAL CELL CARCINOMA (RCC): A COMPREHENSIVE NOMOGRAM INCORPORATING CO-MORBIDITIES Alexander Kutikov, Brian L. Egleston, Marc C. Smaldone, Daniel Canter, Yu-Ning Wong, and Robert G. Uzzo Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , Brian L. EglestonBrian L. Egleston Philadelphia, PA More articles by this author , Marc C. SmaldoneMarc C. Smaldone Philadelphia, PA More articles by this author , Daniel CanterDaniel Canter Philadelphia, PA More articles by this author , Yu-Ning WongYu-Ning Wong Philadelphia, PA More articles by this author , and Robert G. UzzoRobert G. Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1792AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiple risks compete with kidney cancer as the primary cause of death in elderly and/or comorbid patients with localized RCC. These competing factors must be considered against the benefits of treatment. Here we describe the first comprehensive nomogram for competing causes of death in patients with localized RCC, which integrates patient co-morbidities. METHODS 9,098 individuals 66 years or older with localized, node negative RCC were identified in the linked SEER Medicare dataset (1995–2005). We used Fine and Gray's competing risks proportional hazards regressions to predict 5 year probabilities of competing mortality outcomes from kidney cancer death and other cause of death. We used estimated model coefficients to assign points to each characteristic, and predictions from the model to map cumulative point totals for each outcome to estimated probabilities. Prognostic markers included race, sex, tumor size, age, and the Charlson Comorbidity Index (CCI) Score. RESULTS Age and CCI strongly correlated to patient mortality and were most predictive of non-kidney cancer deaths. Increasing tumor size was related to death from kidney cancer and inversely related to death from other causes. Using the nomogram (Figure 1), an 80 year old African American male with a history of a myocardial infarction, moderate renal insufficiency (CCI of 3), and a 4 cm renal mass is expected to have a 5-year mortality of 5% from RCC versus 48% from non-RCC causes. Meanwhile, a 75 year old Caucasian female with no significant co-morbidities (CCI of 0) and a 7 cm renal mass is predicted to have a 5-year mortality of 13% from RCC and 7.5% from other causes. CONCLUSIONS Judicious clinical decisions regarding patients with localized RCC must integrate not only RCC-related variables, but also factors that predict non-kidney cancer death. Here we present a comprehensive nomogram–the first to include patient co-morbidities—which allows quantification and comparison of risks of death from localized RCC and from other causes. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e666 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Kutikov Philadelphia, PA More articles by this author Brian L. Egleston Philadelphia, PA More articles by this author Marc C. Smaldone Philadelphia, PA More articles by this author Daniel Canter Philadelphia, PA More articles by this author Yu-Ning Wong Philadelphia, PA More articles by this author Robert G. Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...