Crafting and Authenticating Prognostic Nomograms for Overall and Cancer-specific Survival in Pediatric Small Renal Masses: A Comprehensive Two-Decade Cohort Study.

Abstract

The intricate task of diagnosing and managing small renal masses (SRMs) has become progressively convoluted within the realm of clinical practice. Contemporary clinical prediction instruments may succumb to a gradual decay in precision, coupled with an absence of unambiguous guidelines to navigate patient management. This investigation was devised to formulate and authenticate nomograms for the overall survival (OS) and cancer- specific survival (CSS) among patients afflicted with SRMs. The study encompassed a cohort of 2558 pediatric patients diagnosed with SRMs over the period of 2000 to 2019. Independent prognostic indicators for OS and CSS, encompassing historical staging, chemotherapy regimens, surgical interventions, and pathological classifications, were ascertained through the employment of multivariate Cox proportional hazards regression analysis and backward stepwise selection. Through the utilization of multivariate Cox regression models, nomograms for OS and CSS were meticulously crafted, demonstrating commendable discrimination and calibration within the training set (OS C-index: 0.762, CSS C-index: 0.779). The validation set further corroborated the exemplary discrimination and calibration of the nomograms. Moreover, these nomograms adeptly differentiated between patient groups at elevated and diminished risk levels. The nomograms delineated in this research provide propitious predictive accuracy for overall survival and cancer-specific survival in patients suffering from pediatric SRMs, thereby contributing to refined risk stratification and steering the optimal therapeutic course of action. The necessity for supplementary validation prevails before the translation of these findings into clinical practice.