Abstract
BackgroundHeterogeneity of metastatic renal cell carcinoma (RCC) constraints accurate prognosis prediction of the tumor. We therefore aimed at developing a novel nomogram for accurate prediction of overall survival (OS) of patients with metastatic RCC.MethodsWe extracted 2010 to 2016 data for metastatic RCC patients in the Surveillance, Epidemiology, and End Results (SEER) database, and randomly stratified them equally into training and validation sets. Prognostic factors for OS were analyzed using Cox regression models, and thereafter integrated into a 1, 3 and 5-year OS predictive nomogram. The nomogram was validated using the training and validation sets. The performance of this model was evaluated by the Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), category-free net reclassification improvement (NRI), index of prediction accuracy (IPA), and decision curve analysis (DCA).ResultsOverall, 2315 metastatic RCC patients in the SEER database who fulfilled our inclusion criteria were utilized in constructing a nomogram for predicting OS of newly diagnosed metastatic RCC patients. The nomogram incorporated eight clinical factors: Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery and bone, brain, liver, and lung metastases, all significantly associated with OS. The model was superior to the American Joint Committee on Cancer (AJCC) staging system (7th edition) both in training (C-indices, 0.701 vs. 0.612, P < 0.001) and validation sets (C-indices, 0.676 vs. 0.600, P < 0.001). The calibration plots of the nomogram corresponded well between predicted and observed values. NRI, IDI, and IPA further validated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed reliable clinical application of our model in prognosis prediction of metastatic RCC patients.ConclusionsWe developed and validated an accurate nomogram for individual OS prediction of metastatic RCC patients. This nomogram can be applied in design of clinical trials, patient counseling, and rationalizing therapeutic modalities.
Highlights
Heterogeneity of metastatic renal cell carcinoma (RCC) constraints accurate prognosis prediction of the tumor
Study population To be included in this study, participants must have first presented with metastasis RCC at diagnosis
The index of prediction accuracy (IPA) estimates for the nomogram were greater than American Joint Committee on Cancer (AJCC) staging estimates in training set (19.6% vs. 7.8, 18.2% vs. 5.9 and 12.8% vs. 0.8%, for 1, 3 and 5-year IPA) and validation set (15.4% vs. 6.7, 15.9% vs. 5.7 and 9.1% vs. 2.9%, for 1, 3 and 5-year IPA). These results demonstrated the superior predictive power of the nomogram for overall survival (OS) over the AJCC staging system
Summary
Heterogeneity of metastatic renal cell carcinoma (RCC) constraints accurate prognosis prediction of the tumor. We aimed at developing a novel nomogram for accurate prediction of overall survival (OS) of patients with metastatic RCC. In 2018 alone, it accounted for 2.2% of new cancer cases and 1.8% of overall cancer deaths worldwide [1]. In the United States alone, new cases and deaths due to kidney and renal pelvis cancer in 2019 were 73,820 and 14,770, respectively [2]. Based on the SEER database, 16% of kidney cancer patients presented with metastatic tumors at diagnosis. The 5-year survival rate of metastatic kidney cancer patients was only 13.0% during the 2010–2016 period [4]. The national Swedish kidney cancer register reported comparable findings, in which between 2005 and 2010, 15–23% of the RCC patients presented with metastatic forms of the disease at diagnosis [5]
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