Abstract
BackgroundClear cell renal cell carcinoma (ccRCC) is expected in the elderly and poor prognosis. We aim to explore prognostic factors of ccRCC in the elderly and construct a nomogram to predict cancer-specific survival (CSS) in elderly patients with ccRCC.MethodsClinicopathological information for all elderly patients with ccRCC from 2004 to 2018 was downloaded from the Surveillance, Epidemiology, and End Results (SEER) program. All patients were randomly assigned to a training cohort (70%) or a validation cohort (30%). Univariate and multivariate Cox regression models were used to identify the independent risk factors for CSS. A new nomogram was constructed to predict CSS at 1-, 3-, and 5 years in elderly patients with ccRCC based on independent risk factors. Subsequently, we used the consistency index (C-index), calibration curves, and the area under the receiver operating curve (AUC) and decision curve analysis (DCA) to test the prediction accuracy of the model.ResultsA total of 33,509 elderly patients with ccRCC were enrolled. Univariate and multivariate Cox regression analyses results showed that age, sex, race, marriage, tumor size, histological grade, tumor, nodes, and metastases (TNM) stage, and surgery were independent risk factors for CSS in elderly patients with ccRCC. We constructed a nomogram to predict CSS in elderly patients with ccRCC. The C-index of the training cohort and validation cohort was 0.81 (95% CI: 0.802–0.818) and 0.818 (95% CI: 0.806–0.830), respectively. The AUC of the training cohort and validation cohort also suggested that the prediction model had good accuracy. The calibration curve showed that the observed value of the prediction model was highly consistent with the predicted value. DCA showed good clinical application value of the nomogram.ConclusionIn this study, we explored prognostic factors in elderly patients with ccRCC. We found that age, sex, marriage, TNM stage, surgery, and tumor size were independent risk factors for CSS. We constructed a new nomogram to predict CSS in elderly patients with ccRCC with good accuracy and reliability, providing clinical guidance for patients and physicians.
Highlights
Renal cell carcinoma (RCC) is a malignant tumor originating from renal tubular epithelial cells
There are several major pathological subtypes of RCC, of which clear cell renal cell carcinoma accounts for 70–80%, with papillary renal cell carcinoma (PRCC) and chromophobe renal cell carcinoma (CRCC) remaining [3, 4]. ccRCC is characterized by rich glycogen and lipids in cells and is manifested as chromosomal 3p deletion and genomic mutation in Von Hippel-Lindau (VHL) tumor suppressor allele [5]
CcRCC is a disease that can be cured by early surgery, such as radical nephrectomy (RN), partial nephrectomy (PN), and local tumor excision represented by radiofrequency ablation (RFA), recurrence and metastasis occur in up to one-third of cases [6]
Summary
Renal cell carcinoma (RCC) is a malignant tumor originating from renal tubular epithelial cells. CcRCC is a disease that can be cured by early surgery, such as radical nephrectomy (RN), partial nephrectomy (PN), and local tumor excision represented by radiofrequency ablation (RFA), recurrence and metastasis occur in up to one-third of cases [6]. These metastases often suggest poor prognosis, which makes the prognosis of ccRCC significantly different from that of other RCCs [7]. With the aging population and the extension of life expectancy, the incidence rate of renal cancer in the elderly is still increasing year by year [2]. Clear cell renal cell carcinoma (ccRCC) is expected in the elderly and poor prognosis. We aim to explore prognostic factors of ccRCC in the elderly and construct a nomogram to predict cancer-specific survival (CSS) in elderly patients with ccRCC
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