Validation Of Nomogram Research Articles

Integrating Downstaging in the Risk Assessment of Patients With Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiotherapy: Validation of Valentini's Nomograms and the Neoadjuvant Rectal Score

BackgroundAdjuvant chemotherapy is controversial in patients with locally advanced rectal cancer after preoperative chemoradiation. Valentini et al developed 3 nomograms (VN) to predict outcomes in these patients. The neoadjuvant rectal score (NAR) was developed after VN to predict survival. We aimed to validate these tools in a retrospective cohort at an academic institution. Patients and MethodsVN and the NAR were applied to 158 consecutive patients with locally advanced rectal cancer treated with chemoradiation followed by surgery. According to the score, they were divided into low, intermediate, or high risk of relapse or death. For statistical analysis, we performed Kaplan-Meier curves, log-rank tests, and Cox regression analysis. ResultsFive-year overall survival was 83%, 77%, and 67% for low-, intermediate-, and high-risk groups, respectively (P = .023), according to VN, and 84%, 71%, and 59% for low-, intermediate-, and high-risk groups, respectively (P = .004), according to NAR. When the score was considered as a continuous variable, a significant association with the risk of death was observed (NAR: hazard ratio, 1.04; P < .001; VN: hazard ratio, 1.10; P < .001). ConclusionWe confirmed the value of these scores to stratify patients according to their individual risk when designing new trials.

Development and external validation of nomograms to predict the risk of skeletal metastasis at the time of diagnosis and skeletal metastasis-free survival in nasopharyngeal carcinoma

BackgroundThe skeletal system is the most common site of distant metastasis in nasopharyngeal carcinoma (NPC); various prognostic factors have been reported for skeletal metastasis, though most studies have focused on a single factor. We aimed to establish nomograms to effectively predict skeletal metastasis at initial diagnosis (SMAD) and skeletal metastasis-free survival (SMFS) in NPC.MethodsA total of 2685 patients with NPC who received bone scintigraphy (BS) and/or 18F–deoxyglucose positron emission tomography/computed tomography (18F–FDG PET/CT) and 2496 patients without skeletal metastasis were retrospectively assessed to develop individual nomograms for SMAD and SMFS. The models were validated externally using separate cohorts of 1329 and 1231 patients treated at two other institutions.ResultsFive independent prognostic factors were included in each nomogram. The SMAD nomogram had a significantly higher c-index than the TNM staging system (training cohort, P = 0.005; validation cohort, P < 0.001). The SMFS nomogram had significantly higher c-index values in the training and validation sets than the TNM staging system (P < 0.001 and P = 0.005, respectively). Three proposed risk stratification groups were created using the nomograms, and enabled significant discrimination of SMFS for each risk group.ConclusionThe prognostic nomograms established in this study enable accurate stratification of distinct risk groups for skeletal metastasis, which may improve counseling and facilitate individualized management of patients with NPC.

Predicting adverse events in patients undergoing hepatectomy—validation of preoperative nomogram and risk score

Background/PurposeMuch research exists on preoperative measures of postoperative mortality in the surgical treatment of liver malignancies, but little on morbidity, a more common outcome. This study aims (i) to validate the published calculations as acceptable measures of postoperative mortality and (ii) to assess the value of these published measures in predicting postoperative morbidity. MethodsData were collected from a prospectively managed dataset of 1059 hepatectomies performed in Louisville, Kentucky from December 1990 to April 2014. Preoperative data were used to assign scores for each of two published measures and the scores were sorted into clinically relevant groups with corresponding ordinal scores, according to the previously published literature (Dhir nomogram and Simons risk score). ResultsAfter selection, 851 hepatectomies were analyzed. Both the Dhir nomogram (p = 0.0004) and Simons risk score (p = 0.0017) were acceptable predictors of postoperative mortality. In the analysis of morbidity, Dhir scores were a poor predictor of morbidity. The Simons ordinal risk score was predictive of complications (p = 0.0029), the number of complications (p = 0.0028), complication grade (p = 0.0033), and hepatic-specific complications (p = 0.0003). ConclusionThe Simons ordinal risk score can be useful in assessing postoperative morbidity among hepatectomy patients.

Development and validation of nomogram based on lncRNA ZFAS1 for predicting survival in lymph node-negative esophageal squamous cell carcinoma patients.

BackgroundThere is increasing evidence of a relationship between long non-coding RNA (lncRNA) and cancer. This study aimed to examine the prognostic value of the lncRNA ZFAS1 in esophageal squamous cell carcinoma (ESCC).ResultsThe results showed that ZFAS1 expression was significantly higher in ESCC tissues compared with the corresponding adjacent normal tissues (P < 0.001). ESCC patients with high ZFAS1 expression had a poor overall survival (OS). Histological grade, T stage and ZFAS1 expression were integrated to develop the nomogram. The nomogram showed a significantly better prediction of OS for patients with lymph node-negative ESCC. The ROC curve also showed higher specificity and sensitivity for predicting 3- and 5-year ESCC patient survival compared with the AJCC staging system. The decision curve analysis also indicated a greater potential for the nomogram in clinical application compared with the AJCC staging system. Importantly, our findings were supported by a validation cohort.Materials and MethodsWe retrospectively investigated 398 lymph node-negative ESCC patients. Data from the primary cohort (n = 246) were used to develop a multivariate nomogram. The nomogram was internally validated for discrimination and calibration with bootstrap samples and was externally validated with an independent patient cohort (n = 152).ConclusionsOur proposed nomogram, which integrates clinicopathological factors and ZFAS1 expression, can accurately predict the prognosis of lymph node-negative ESCC patients without preoperative chemoradiotherapy.

Development and validation of nomogram based on miR-203 and clinicopathological characteristics predicting survival after neoadjuvant chemotherapy and surgery for patients with non-metastatic osteosarcoma.

BackgroundRecently, nomograms have been used as models for risk prediction in malignant tumor because they can predict the outcome of interest for a certain individual based on many variables. This study aimed to establish an effective prognostic nomogram for osteosarcoma based on the clinicopathological factors and microRNA-203.ResultsThe results showed that miR-203 expression was significantly lower in osteosarcoma tissues compared with the corresponding adjacent tissues (P < 0.001). Patients with low miR-203 expression had poor overall survival (OS) in osteosarcoma. The histological type, tumor size, AJCC stage and miR-203 expression were integrated in the nomogram. The nomogram showed significantly better prediction of OS than for patients with non-metastatic osteosarcoma. The ROC curve also showed higher specificity and sensitivity for predicting 3- and 5-year osteosarcoma patients’ survival compared with AJCC stage. The decision curve analysis also indicated more potential of clinical application of the nomogram compared with AJCC staging system. Moreover, our findings were supported by the validation cohort.Materials and MethodsWe retrospectively investigated 301 patients with non-metastatic osteosarcoma. Data from primary cohort (n = 198) were used to develop multivariate nomograms. This nomogram was internally validated for discrimination and calibration with bootstrap samples and was externally validated with an independent patient cohort (n = 103).ConclusionsOur proposed nomogram showed more accurate prognostic prediction for patients with non-metastatic osteosarcoma.

External validation of a nomogram for identification of pathologically favorable disease in intermediate risk prostate cancer patients

To establish an external validation of the new nomogram from Gandaglia et al which provides estimates of the probability of pathological favorable disease in pre-operatively defined intermediate-risk PCa. Overall, 2928 intermediate-risk PCa patients according to the D'Amico classification undergoing RP and bilateral lymph node dissection in seven academic centres between 2000 and 2011. Pathologically favorable PCa was defined as low-grade organ-confined disease. The Receiver Operating Characteristic (ROC) curve was obtained to quantify the overall accuracy (Area Under the Curve, AUC) of the model to predict specimen-confined (SC) disease. Calibration curve was then constructed to illustrate the relationship between the risk-estimates obtained by the model and the observed proportion of SC disease. Kaplan-Meier method was used for PSA recurrence-free survival (PSA-RFS) assessment. Median age was 68 years. 10.6% patients finally presented pathologically favorable disease characteristics at RP. A higher PSAD (OR = 0.01; 95%CI = 0.00-0.04; P < 0.0001) and percentage of positive cores (OR = 0.97; 95%CI = 0.96-0.98; P < 0.0001) were associated with a reduced probability of favorable disease at RP in multivariate analysis. ROC curve analysis showed strongest accuracy of the model (AUC = 0.82; 95%CI = 0.79-0.84). Favorable PCa had a significantly better PSA recurrence-free survival rates as compared to unfavorable PCa after RP (94.2% vs 74.4% at 4 years, P < 0.0001). This external validation of the Gandaglia nomogram shows relevant accuracy with one out of ten patients in this intermediate risk PCa group with pathologically proven organ-confined disease. This validated risk calculator can help physician to distinguish favorable intermediate risk PCa that can be treated by conservative approach or safer nerve-sparing surgery.

Development and validation of nomograms for predicting survival in patients with non-metastatic colorectal cancer.

BackgroundThis study aimed to develop nomograms for predicting survival in patients with non-metastatic colorectal cancer (CRC).ResultsOn multivariate analyses of the derivation set, the nomograms for OS and CSS shared common significant prognostic factors: age, first-degree relative cancer history, differentiation grade, vessels/nerves invasion, TNM stage, CEA, CA19-9 and PNI. The nomograms displayed good accuracy in predicting OS and CSS, with C-indexes of 0.75 and 0.76, respectively. The calibration plots also showed an excellent agreement between the predicted and observed survival probabilities. Furthermore, the predictive accuracy of the nomograms was confirmed in the validation set, with C-indexes of 0.79 and 0.83 for OS and CSS, respectively.Materials and MethodsOn the basis of data from 822 patients with resected non-metastatic CRC, nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) were established using Cox regression model. The predictive performance of the nomograms was assessed by concordance index (C-index) and calibration plot. An independent external cohort of 171 patients was used to validate the nomograms.ConclusionsWe developed and validated two nomograms for patients with non-metastatic CRC, which could provide individual prediction of OS and CSS with high accuracy.

Abstract P2-01-26: Validation of a Chinese nomogram with a Dutch breast cancer population: Excellent prediction of the probability of axillary lymph node metastasis

Abstract Background: In the era of precision medicine, the surgical management of axillary lymph nodes (ALN) should be patient-tailored. Omission of sentinel lymph node biopsy (SLNB) is possible in patients with early breast cancer and very low or very high probability of ALN metastasis. Recently, we developed a nomogram to predict the probability of ALN metastasis in breast cancer patients based on clinicopathological parameters including ultrasound using a Chinese patient dataset1. In this study the nomogram performance was validated in an independent Dutch population from one hospital. Methods: Data of 170 Dutch patients with a successful SLNB or axillary lymph node dissection were collected. A lymph node containing either micro- or macrometastatic disease was considered as a positive lymph node. Performance of the nomogram was assessed by calculating the area under the receiver-operator characteristic (ROC) curve (AUC). False-negative rates (FNRs) and false-positive rates (FPRs) at several different predictive cut-off points were calculated. Results: There were 69 (40.6%) patients having a positive ALN. The AUC for the nomogram was 0.84 (95% confidence interval 0.78-0.90) compared with 0.86 in the Chinese validation population, showing excellent discrimination of the model. The FNR and FPR of the model were 10.2% and 0% for the predicted probability cut-off points of 14.5% and 90%, respectively. Table 1 False-negative rates (FNRs) and false-positive rates (FPRs) of the nomogram at different predictive cut-off pointsPredicted rishPatient number and percentage (%)Number of patients with positive ALNFNR (%)&amp;lt; 14.5%59 (34.7)610.2&amp;lt; 20%79 (46.5)1113.9 Number of patients with negative ALNFPR (%)&amp;gt; 70%27 (15.9)13.7&amp;gt; 90%18 (10.6)00ALN: axillary lymph node This means that omission of SLNB is possible for patients with a predictive probability of less than 14.5% or higher than 90%, which accounts for 45.3% of all patients in this study. Conclusions and future perspectives: In this study, the Chinese nomogram showed excellent performance in predicting the probability of ALN metastasis in an independent Dutch population. A multicentre validation of this nomogram in large Dutch patient population (&amp;gt;2500 patients) is ongoing. Reference 1.Qiu S-Q, Zeng H-C, Zhang F, et al. A nomogram to predict the probability of axillary lymph node metastasis in early breast cancer patients with positive axillary ultrasound. Sci Rep 2016; 6: 21196. Citation Format: Qiu S-Q, Aarnink M, van Maaren MC, Dorrius M, Koffijberg H, van Dam GM, Siesling S. Validation of a Chinese nomogram with a Dutch breast cancer population: Excellent prediction of the probability of axillary lymph node metastasis [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-01-26.

External Validation of a Gastric Cancer Nomogram Derived from a Large-volume Center Using Dataset from a Medium-volume Center.

PurposeRecently, a nomogram predicting overall survival after gastric resection was developed and externally validated in Korea and Japan. However, this gastric cancer nomogram is derived from large-volume centers, and the applicability of the nomogram in smaller centers must be proven. The purpose of this study is to externally validate the gastric cancer nomogram using a dataset from a medium-volume center in Korea.Materials and MethodsWe retrospectively analyzed 610 patients who underwent radical gastrectomy for gastric cancer from August 1, 2005 to December 31, 2011. Age, sex, number of metastatic lymph nodes (LNs), number of examined LNs, depth of invasion, and location of the tumor were investigated as variables for validation of the nomogram. Both discrimination and calibration of the nomogram were evaluated.ResultsThe discrimination was evaluated using Harrell's C-index. The Harrell's C-index was 0.83 and the discrimination of the gastric cancer nomogram was appropriate. Regarding calibration, the 95% confidence interval of predicted survival appeared to be on the ideal reference line except in the poorest survival group. However, we observed a tendency for actual survival to be constantly higher than predicted survival in this cohort.ConclusionsAlthough the discrimination power was good, actual survival was slightly higher than that predicted by the nomogram. This phenomenon might be explained by elongated life span in the recent patient cohort due to advances in adjuvant chemotherapy and improved nutritional status. Future gastric cancer nomograms should consider elongated life span with the passage of time.

Validation of Nomograms for Survival and Metastases after Hysterectomy and Adjuvant Therapy in Uterine Cervical Cancer with Risk Factors.

Background. Three nomogram models for early stage uterine cervical cancer have been developed (KROG 13-03 for overall survival [OS], SNUH/AMC for disease-free survival [DFS], and KROG 12-08 for distant metastases-free survival [DMFS]) after radical hysterectomy (RH) and pelvic lymph node dissection (PLND). This study aimed to validate these models using our cohort with adjuvant radiotherapy. Methods. According to the eligibility criteria of nomogram studies, patients were enrolled in Group A (N = 109) for the two KROG models (RH with PLND and whole pelvic irradiation) and Group B (N = 101) for the SNUH/AMC model (RH with PLND and squamous histology). Using Cox-regression hazard models, the prognostic factors of our cohorts were evaluated. The risk probabilities induced from published nomogram scores were calculated and the concordance indices were evaluated. Results. Group A had 88.1% 5-year OS and 86.0% 5-year DMFS. Group B had 83.0% 5-year DFS. In multivariate analyses, large tumor size for OS (HR 8.62, P < 0.001) and DMFS (HR 5.13, P = 0.003), young age (≤40 versus 41–64 years) for OS (HR 4.63, P = 0.097) and DFS (HR 3.44, P = 0.051), and multiple lymph node metastases (0 versus ≥3) for DMFS (HR 4.03, P = 0.031) and DFS (HR 3.90, P = 0.038) were significantly correlated. The concordance indices for OS, DMFS, and DFS were 0.612 (P = 0.002), 0.597 (P = 0.014), and 0.587 (P = 0.020), respectively. Conclusion. The developed nomogram models after RH and PLND are clinically useful in predicting various types of survival with significance.

Establishment and evaluation of nomogram for predicting biochemical recurrence in patients with locally adverse pathologic features after radical prostatectomy

Objective To construct and evaluate a nomogram for predicting biochemical recurrence (BCR) in patients with locally adverse pathologic features (including seminal vesicle invasion (SVI), extracapsular extension (ECE), or positive surgical margins (PSM)) after radical prostatectomy. Methods This study included prostate cancer patients who were treated with radical prostatectomy (RP) at a single institution between 2003 and 2014, with locally adverse pathological features. The final study comprised of 172 men (median age, 70 years) with a median serum PSA level of 16.1 ng/ml. According to the modified Gleason grade system, the distribution of biopsy Gleason score was as follows: Gleason≤6 (59, 34.3%), Gleason 3+ 4 (51, 29.7%), Gleason 4+ 3 (42, 24.4%), Gleason 8 (18, 10.5%), and Gleason 9-10 (2, 1.2%). Most patients were preoperatively under-staged, with 91.3% of cases had a clinical stage less than T2c. Pathological examination of the species revealed ECE in 108 (62.8%) patients, SVI in 40 (23.3%) patients and PSM in 62 (36.0%) patients. Considering the modified Gleason grading system, the distribution of the patients was as follows: Gleason≤6 (35, 20.3%), Gleason 3+ 4 (54, 31.4%), Gleason 4+ 3 (42, 24.4%), Gleason 8 (23, 13.4%), and Gleason 9-10 (18, 10.5%). Overall, there were 79.1% of patients had early postoperative PSA <0.1 ng/ml. Univariate and multivariate Cox regression analysis the value of factors in predicting the probability of BCR. Variables significantly associated with BCR were included to construct the nomogram. Concordance index and calibration curve were used for the internal validation of nomogram. Results The overall 3-year and 5-year BCR-free survival rate was 60.4% and 43.2% respectively for the entire cohort. In univariate Cox regression analysis, Preoperative PSA(HR=1.474, P<0.05), Early postoperative PSA(HR=3.488, P<0.05), SVI(HR=3.488, P<0.05), PSM(HR=1.795, P<0.05), biopsy Gleason grade(HR=1.795, P<0.05) and specimen Gleason grade(HR=1.898, P<0.05) were significantly associated with BCR. However, in multivariate analysis, only specimen Gleason grade(HR=1.809, P<0.05) and early postoperative PSA(HR=2.490, P<0.05) retained independent significance. The nomogram predicting the risk of BCR showed relative good concordance index (0.766) and good calibration. Conclusions The nomogram to predict the probability of BCR in patients with locally adverse pathologic features after radical prostatectomy showed good clinical applicability. This statistical tool may facilitate discussions at the point of treatment decision making. Key words: Prostatic neoplasms; Radical prostatectomy; Biochemical recurrence; Risk factors; Nomogram

30 - Validation of risk nomogram to predict lymph node invasion in prostate cancer patients undergoing lymph node dissection

30 - Validation of risk nomogram to predict lymph node invasion in prostate cancer patients undergoing lymph node dissection

OC-025 Application of a Survival Nomogram for Palliative Cancer Patients on Home Parenteral Nutrition: Is It Valid?

Introduction Home parenteral nutrition (HPN) for palliative malignancy is increasing and optimal selection of patients remains challenging. A nomogram predicting survival length 1 based on Glasgow prognostic score (CRP and albumin), primary cancer, metastases & Karnofski performance status has recently been developed. In the nomogram survival was calculated from discharge date, rather than the date of PN commenced. We aimed to test the validity of the nomogram by retrospectively applying it to a cohort of HPN palliative cancer patients at St Mark’s Hospital & University Hospital Southampton. Methods Adult patients with palliative cancer started on HPN were identified between 1/1/05 and 1/12/15. Patients were excluded with a diagnosis of psuedomyxoma or if a cancer developed while on HPN. Karnofski performance status was assigned though MDT discussion. Results 47 patients met the inclusion criteria, 44 patients had sufficient data to complete the nomogram. There were 9 ovarian, 26 GI and 9 ‘other’ cancers (metastasis in 77%). Median survival for ovarian cancers was 100 days, GI cancers 55 days & other primaries 15 days. The nomogram over or underestimated survival length by ≤25%, 25–50%, ≥50% in 40%, 20% and 40% of patients, respectively. 12 patients were predicted to live Conclusion This data does not validate the use of this nomogram to predict survival length in HPN palliative malignancy patients. In our cohort the data shows that this nomogram most often under estimates survival. The retrospective nature of this study and relatively small number of patients is a limiting factor. Further prospective studies are needed and it is recommended defining survival as measured from date PN commenced. At present the best judge for considering palliative HPN is clinical acumen & patient performance status. Reference 1 Bozzetti F, Cotogni P, Lo Vullo S, Pironi L, Giardiello D, Mariani L. Development and validation of a nomogram to predict survival in incurable cachectic cancer patients on home parenteral nutrition. Ann Oncol 2015; 26 (11):2335–2340. Disclosure of Interest None Declared

External validation of nomograms predicting survival of women with locally advanced cervical cancer

External validation of nomograms predicting survival of women with locally advanced cervical cancer

Development and validation of a prognostic nomogram based on the log odds of positive lymph nodes (LODDS) for breast cancer.

BackgroundTo evaluate the prognostic effect of log odds of positive lymph nodes (LODDS) and develop a nomogram for survival prediction in breast cancer patients at the time of surgery.ResultsLODDS was an independent risk factor for cancer-related death in breast cancer (hazard ratio: 1.582, 95%CI: 1.190-2.104). Menopausal status, tumor size, pathological lymph node staging, estrogen receptor status and human epidermal growth factor receptor-2 status were also included in the nomogram. The calibration plots indicated optimal agreement between the nomogram prediction and actual observation. Discrimination of nomogram was superior to the seventh edition TNM staging system [C-index: 0.745 vs. 0.721 (p = 0.03) in training cohort; 0.796 vs. 0.726 (p < 0.01) in validation cohort].MethodsWe retrospectively evaluated 2023 breast cancer patients from Jan 2002 to Dec 2008 at our center. The cohort was randomly divided into training cohort and validation cohort. Univariate and multivariate analyses were performed to identify prognostic factors, and nomogram was established using Cox regression model in training cohort. External validation of the nomogram was performed in the validation cohort.ConclusionsThe LODDS is an independent prognostic indicator in breast cancer and the novel nomogram can provide individual prediction of cancer-specific survival and help prognostic assessment for breast cancer patients.

Establishment and validation of prognostic nomograms including HER2 status in metastatic gastric cancer.

24 Background: It remains unclear whether human epidermal growth factor receptor 2 (HER2) status is an outcome-associated biomarker independent of known prognostic factors for metastatic gastric cancer (MGC). There are few reports on nomograms in MGC, while several studies have been published on nomograms for other cancer types. This retrospective study aimed to develop nomograms that combine HER2 status and other prognostic factors for predicting survival outcome of individual patients with MGC starting first-line treatment. Methods: We used a training set of 838 consecutive patients with MGC starting first-line chemotherapy between 2005 and 2012 in Aichi Cancer Center Hospital (ACC) to establish nomograms that calculate the predicted probability of survival at different time points; overall survival (OS) at 1 and 2 years. The covariates analyzed in this model by Cox proportional hazard models included HER2 status, Eastern Cooperative Oncology Group performance status (PS), history of gastrectomy, serum lactic acid dehydrogenase (LDH), and serum alkaline phosphatase levels (ALP). Nomograms were independently validated using data on 269 consecutive patients with MGC who underwent first-line chemotherapy between 2010 and 2012 in Shizuoka Cancer Center Hospital (SCC). Missing covariate data were estimated using multiple imputation methods. The discriminatory ability and accuracy of the models were assessed using Harrell’s c-index. IHC3+ or IHC2+/ISH+ tumors were defined as HER2-positive. Results: Patient characteristics were as follows: median age, 64 vs. 66 years; ECOG PS 0/1/2, 34%/51%/15% vs. 45%/44%/11%; prior gastrectomy, 42% vs. 39%; 1/ &gt; 1 metastatic sites, 56%/44% vs. 43%/57%; high LDH, 76% vs. 27%; high ALP, 22% vs. 26%; and positive/negative HER2 status, 10%/45% vs. 7%/53%, respectively. At a median follow-up of 12.3 (ACC) and 11.6 (SCC) months, 782 and 248 patients had died, and median OS was 12.5 and 12.4 months (P= 1.00), respectively. The nomograms were capable of predicting an OS with a c-index of 0.68 and 0.58. Conclusions: These nomograms may provide objective and approximate prediction of OS for individual MGC patients in clinical settings.

Validation of nomogram for disease free survival for colon cancer in UK population: A prospective cohort study

AimsTo externally validate the MSKCC nomogram in a UK population, and determine if it could be used in our practice here in the UK. MethodsThe colon cancer database from a district general hospital in England was used to extract all patients who had a curative colon cancer resection. Inclusion criteria were all patients who had curative elective colon cancer resection between 01/01/1998 and 31/12/2003. Patients were followed up for up to ten years. Five and ten year predictions were calculated for each patient, and plotted against the actual recurrence using a ROC curve, and AUC was calculated for both the five and ten year nomogram. Results138 patients were included in the study. Overall five year recurrence rate was 26.8% with a mean follow up of 60.24 months (SD = 38.6). 118 patients were included in the five year nomogram validation, and 102 patients were included in the ten year nomogram validation. A ROC curve was plotted for both the five and ten year nomogram and AUC was calculated. For the five year nomogram AUC was 0.673, and for the ten year nomogram AUC was 0.687. Two cut off points were identified for each nomogram and this divided the cohort into low, medium and high risk groups for recurrence. Cox regression showed there was significant difference between all groups for both nomograms. ConclusionThe MSKCC colon cancer nomogram was validated in our cohort, but it is recommended to be used in conjunction with AJCC TNM staging system.

Inclusion of corrected calcium and creatinine levels in a novel nomogram for prediction of pathologically localized prostate cancer.

140 Background: The role of routine parameters in the prediction of organ-confined Prostate Cancer (oPCa) remains unclear. Methods: We conducted a retrospective study of 246 patients with PCa diagnosed on biopsy, who underwent radical prostatectomy with extended lymph node dissection. None of these patients received a neoadjuvant therapy. Gleason score (xGLS), percent of positive cores involved by PCa (pCores), results of transrectal evaluation (TRUS, DRE), prostate volume (PVol), albumin-corrected Calcium (Ca), Hemoglobin (Hb), Creatinine (Crea), PSA, and age at RPE were considered. Postoperative variables including Gleason score (pGLS), TNM stages were evaluated. These patients were divided according to disease advancement into pathologically localized (pT2) and advanced PCa (pT3/4 or pN1). A L2 penalized regression model including all preoperative parameters was evaluated to design a nomogram for oPCa prediction. Furthermore, the internal validation of the nomogram was performed using bootstrapping and cross-validations. The precision and accuracy of the novel nomogram were evaluated by using AUC, F-Score, Brier-Score and the classification accuracy (CA). Results: The lowest probability for pathologically localized PCa was found in patients having the following features: PSA &gt; 20 ng/ml, detection of PCa in all cores, high Ca [1.21 fold over upper normal limit (ULN)] and Crea levels (2.27 fold over ULN), xGls &gt; 7 and normal PVol. A nomogram for oPCa was developed including the following parameter: Crea, Ca, PSA, xGls, PVol, TRUS, pCores. The sensitivity and the specificity of the nomogram for prediction of pathologically localized PCa were 92.2% and 35.9%, respectively. AUC of 0.811, CA of 80.1%, F-Score 0.879, a precision of 84.0%. and Brier-Score of 0.2599 were calculated. The predicted probability of the novel nomogram was associated with higher accuracy for prediction of oPCa compared to those of Partin table and Kattan nomogram. Conclusions: Serum creatinine and corrected calcium are indpendent predictors of oPCa. The novel nomogram can predict oPCa with high precision and accuracy. However, an external validation of the novel nomogram is needed.

Prognostic factors of primary resected retroperitoneal soft tissue sarcoma: Analysis from a single asian tertiary center and external validation of gronchi's nomogram.

Surgery is the potentially curative treatment for retroperitoneal sarcoma (RS), but complete resectability is frequently a challenge. This study aimed to characterize the clinical features, prognostic factors and treatment outcomes. A cohort of 144 patients with RS was surveyed retrospectively from January 1st, 2000 to July 30th, 2011. The prognostic influence of clinicopathological characteristics as well as treatments on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS), were examined by univariate and multivariate analyses. A histology-specific nomogram developed by Gronchi et al was used for validation. Liposarcoma, leiomyosarcoma, and malignant peripheral sheath tumor (MPNST) were the most common histologies (70%). Multivariate analysis revealed FNCLCC tumor grade was the most significant prognostic factor for OS (P = 0.001) and DMFS (P < 0.001) and complete resection was the only significant prognostic factor for LRFS (P = 0.043). Incomplete resection of grade 3 tumor was significantly associated with a worse OS. Despite some differences in characteristics between our patients and Gronchi's cohort, external validation of Gronchi's nomogram demonstrated excellent concordance in predicting survival. Our study demonstrated tumor grade and surgical margins had significant prognostic influence and the Gronchi's nomogram has an excellent applicability in predicting survival of STS patients. J. Surg. Oncol. 2016;113:355-360. © 2016 Wiley Periodicals, Inc.

Development and validation of a prognostic nomogram for progression-free survival in patients with advanced renal cell carcinoma treated with pazopanib

Цель исследования – разработка и валидация номограммы, позволяющей прогнозировать 12-месячную выживаемость без прогрессирования (ВБП) у пациентов, получающих пазопаниб в качестве первой линии терапии распространенного рака почки. Материалы и методы. Проведено статистическое моделирование данных 557 пациентов, получавших пазопаниб, в исследовании III фазы COMPARZ. Известные прогностические факторы были внесены в мультивариантную модель по Cox. Рассмотренные параметры включали уровень нейтрофилов, содержание альбумина и щелочной фосфатазы в сыворотке, время между постановкой диагноза и началом лечения, а также наличие костных метастазов. Для валидации были использованы данные по группе участников плацебоконтролируемого исследования III фазы, получавших пазопаниб. Результаты. Данная модель включала 10 прогностических факторов, представленных в виде номограммы, позволяющей прогнозировать 12-месячную ВБП. Сопоставления, проведенные с целью калибровки разработанной модели, позволяют предполагать достаточное соответствие расчетных вероятностей ВБП ее фактическим показателям. Индекс конкордантности для 12-месячной ВБП составил 0,625. Отмечена достоверная взаимосвязь (p < 0,05) между ВБП и наличием костных метастазов, интервалом времени между постановкой диагноза и началом лечения, а также уровнями альбумина и щелочной фосфатазы. Прогностическая роль последних 2 параметров оказалась весьма существенной. Выводы. Номограмма позволяет с достаточной точностью прогнозировать ВБП у пациентов с распространенным раком почки, получающих пазопаниб, в зависимости от исходных клинических характеристик.