Development and validation of nomogram based on a novel platelet index score to predict prognosis in patients with renal cell carcinoma

Ruotao Xiao; Yanchun Qin; Lei Liu; Zhigang Chen; Bin Yang; Chuxiao Xu; Wei He; Cheng Liu; Lulin Ma

doi:10.7150/jca.60268

Development and validation of nomogram based on a novel platelet index score to predict prognosis in patients with renal cell carcinoma

J Cancer. 2021 Aug 28;12(21):6301-6309. doi: 10.7150/jca.60268. eCollection 2021.

Authors

Ruotao Xiao¹, Yanchun Qin¹, Lei Liu¹, Zhigang Chen¹, Bin Yang¹, Chuxiao Xu¹, Wei He¹, Cheng Liu¹, Lulin Ma¹

Affiliation

¹ Department of Urology, Peking University Third Hospital, Beijing, China.

Abstract

Purpose: This study aims to develop and validate a nomogram based on a novel platelet index score (PIS) to predict prognosis in patients with renal cell carcinoma (RCC). Patients and methods: We retrospectively analyzed the data of 759 consecutive patients with RCC. The Kaplan-Meier curves were performed to analyze the platelet parameters and PIS was established. The patients were randomly divided into training (N=456, 60%) and validation cohorts (N=303, 40%). The nomogram was created based on the factors determined by multivariable Cox proportional hazard regression of the training cohort. We assessed the discrimination and calibration of our nomogram in both training and validation cohorts. And then the nomogram was compared with other reported models. Results: High platelet count (PLT>285×10⁹/L) and low platelet distribution width (PDW≤10.95fL) were associated with shorter progression-free survival (PFS). Thus, PLT and PDW were incorporated in a novel score system called PIS. On multivariable analysis of training cohort, PIS, American Joint Committee on Cancer (AJCC) stage, and sarcomatoid differentiation were independent prognostic factors, which were all selected into the nomogram. The nomogram exhibited good discrimination in both training (C-index: 0.835) and validation cohorts (C-index: 0.883). The calibration curves also showed good agreement between prediction and observation in both cohorts. The C-index of the nomogram (C-index: 0.810~0.902) for predicting 2-year, 3-year, and 4-year PFS were significantly higher than Leibovich (C-index: 0.772~0.813), SSIGN (C-index: 0.775~0.876), Cindolo (C-index: 0.642~0.798), Yaycioglu (C-index: 0.648~0.804), MSKCC (C-index: 0.761~0.862), Karakiewicz (C-index: 0.747~0.851), and AJCC stage models (C-index: 0.759~0.864). Conclusion: The nomogram based on a novel PIS could offer better risk stratification in patients with RCC.

Keywords: nomogram; platelet count; platelet distribution width; platelet index score; progression-free survival; renal cell carcinoma.