Prognostic nomograms based on log odds of positive lymph nodes for patients with renal cell carcinoma: A retrospective cohort study

WeiWen Zhou; ChuiGuo Huang; NaiJun Yuan

doi:10.1016/j.ijsu.2018.10.038

Prognostic nomograms based on log odds of positive lymph nodes for patients with renal cell carcinoma: A retrospective cohort study

Int J Surg. 2018 Dec:60:28-40. doi: 10.1016/j.ijsu.2018.10.038. Epub 2018 Oct 30.

Authors

WeiWen Zhou¹, ChuiGuo Huang², NaiJun Yuan³

Affiliations

¹ Department of Emergency Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong Province, China. Electronic address: zhouweiwen.sys@gmail.com.
² Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, Henan Province, China. Electronic address: huangcg0727@163.com.
³ The School of Traditional Chinese Medicine of Jinan University, Guangzhou 510632, Guangdong Province, China. Electronic address: naijun_yuan@stu2015.jnu.edu.cn.

PMID: 30389534
DOI: 10.1016/j.ijsu.2018.10.038

Abstract

Objectives: The aim of the current study is to build prognostic nomograms for patients with renal cell carcinoma (RCC) and compare the predictive performance with the American Joint Committee on Cancer (AJCC) staging system.

Methods: A total of 9453 patients were identified (2005-2015) from the Surveillance Epidemiology and End Results (SEER) database. Propensity-score matching (PSM) was conducted to reduce selective bias. The matched cohort was further divided equally into the development and the validation cohort. Nomograms based on log odds of positive lymph nodes (LODDS) were formulated to predict individualized cancer-specific survival (CSS) and overall survival (OS) for RCC. Then, the performance of nomograms was internally and externally validated via the concordance index (C-index) and calibration plots. Decision curve analysis (DCA) was used to compare the clinical practicable between nomograms and AJCC staging system.

Results: LODDS was identified as an independent prognostic indicator for CSS and OS using univariate and multivariate Cox regression analyses. Two nomograms incorporating LODDS were formulated. The C-indices of the nomograms for predicting CSS and OS were 0.7561 (95% CI, 0.7356-0.7766) and 0.7140 (95% CI, 0.6936-0.7343) in the development cohort, which was higher than C-index of the AJCC staging system. The results were reproducible in the validation cohort. Moreover, internal and external calibration plots showed that the nomograms-predicted was consistent with the actual observation. Additionally, DCA demonstrated that the nomograms were superior to the AJCC staging system with obtaining more clinical net benefit.

Conclusions: LODDS could be considered as a reliable prognostic factor for patients with RCC. Two nomograms were able to more accurately and applicable than the AJCC staging system for predicting CSS and OS.

Keywords: Cancer-specific survival; Log odds of positive lymph nodes; Nomogram; Overall survival; Renal cell carcinoma.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Renal Cell / mortality
Carcinoma, Renal Cell / pathology*
Cohort Studies
Databases, Factual
Decision Support Techniques
Female
Humans
Kidney Neoplasms / mortality
Kidney Neoplasms / pathology*
Lymph Nodes / pathology*
Lymphatic Metastasis / pathology*
Male
Middle Aged
Multivariate Analysis
Neoplasm Staging
Nomograms*
Prognosis
Propensity Score
Reproducibility of Results
Retrospective Studies
Survival Analysis
Young Adult