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Multi-Institutional Validation of a New Renal Cancer–Specific Survival Nomogram

Pierre I. Karakiewicz, Alberto Briganti, Felix K.-H. Chun, Quoc-Dien Trinh, Paul Perrotte, Vincenzo Ficarra, Luca Cindolo, Alexandre De La Taille, Jacques Tostain, Peter F.A. Mulders, Laurent Salomon, Richard Zigeuner, Tommaso Prayer-Galetti, Denis Chautard, Antoine Valeri, Eric Lechevallier, Jean-Luc Descotes, Herve Lang, Arnaud Mejean, Jean-Jacques Patard

From the Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, University of Verona, Verona; Urology Unit, G. Rummo Hospital, Benevento; Department of Urology, University of Padua, Padua, Italy; Department of Urology, Henri Mondor University Hospital, Creteil; Department of Urology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne; Department of Urology, Angers University Hospital, Angers; Department of Urology, Rennes 1 University Hospital, Rennes; Comité de Cancérologie de l'Association Française d'Urologie, France; Department of Urology, University Medical Center, Nijmegen, the Netherlands; and the Department of Urology, University Hospital, Medical University of Graz, Graz, Austria

Address reprint requests to Pierre I. Karakiewicz, MD, Cancer Prognostics and Health Outcome Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal, Quebec, Canada H2X 3J4; e-mail: pierre.karakiewicz{at}umontreal.ca

Purpose: We tested the hypothesis that the prediction of renal cancer–specific survival can be improved if traditional predictor variables are used within a prognostic nomogram.

Patients and Methods: Two cohorts of patients treated with either radical or partial nephrectomy for renal cortical tumors were used: one (n = 2,530) for nomogram development and for internal validation (200 bootstrap resamples), and a second (n = 1,422) for external validation. Cox proportional hazards regression analyses modeled the 2002 TNM stages, tumor size, Fuhrman grade, histologic subtype, local symptoms, age, and sex. The accuracy of the nomogram was compared with an established staging scheme.

Results: Cancer-specific mortality was observed in 598 (23.6%) patients, whereas 200 (7.9%) died as a result of other causes. Follow-up ranged from 0.1 to 286 months (median, 38.8 months). External validation of the nomogram at 1, 2, 5, and 10 years after nephrectomy revealed predictive accuracy of 87.8%, 89.2%, 86.7%, and 88.8%, respectively. Conversely, the alternative staging scheme predicting at 2 and 5 years was less accurate, as evidenced by 86.1% (P = .006) and 83.9% (P = .02) estimates.

Conclusion: The new nomogram is more contemporary, provides predictions that reach further in time and, compared with its alternative, which predicts at 2 and 5 years, generates 3.1% and 2.8% more accurate predictions, respectively.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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