Validation of the current prognostic models for nonmetastatic renal cell carcinoma after nephrectomy in Chinese population: A 15-year single center experience

• Published in: International journal of urology Vol. 16; no. 3; pp. 268 - 273
• Main Authors: Liu, Zheng, Lv, Jiaju, Ding, Kejia, Fu, Qiang, Cao, Qingwei, Wang, Facheng
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.03.2009
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Cause of Death; Cohort Studies; Confidence Intervals; Female; Humans; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Middle Aged; Neoplasm Staging; Nephrectomy - methods; Nephrectomy - mortality; Postoperative Complications - mortality; Probability; Prognosis; prognostic models; renal cell carcinoma; Retrospective Studies; Risk Assessment; Sex Factors; Statistics, Nonparametric; Survival Analysis; validation; Young Adult
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/j.1442-2042.2008.02229.x

Objectives:  To explore the applicability of the current prognostic models for nonmetastatic renal cell carcinoma in the Chinese population based on a single center experience. Methods:  Clinical and pathological variables of 653 nonmetastatic renal cell carcinoma patients were retrospectively reviewed. Seven models were used to predict the prognosis, including the Yaycioglu model, the Cindolo model, the University of California Los Angeles Integrated Staging System model, the stage, size, grade, and necrosis model, the Kattan nomogram, the Sorbellini nomogram and the Karakiewicz nomogram. Three different end‐points were used for validation, including overall survival, cancer‐specific survival, and recurrence‐free survival. Survival was estimated using the Kaplan–Meier method. Discriminating ability was assessed using the Harrell's concordance‐index. Results:  At the last follow up, 159 patients had died due to various causes, and disease recurrence occurred in 156 patients. The discriminating ability of all models was confirmed in the Chinese population. Nomograms discriminate better than algorithms, regardless of end‐points. The Kattan nomogram was the most accurate, with the highest concordance‐indexes of 0.752, 0.793 and 0.841 for overall survival, cancer‐specific survival, and recurrence‐free survival, respectively. Conclusions:  The current prognostic models were developed and validated entirely based on Caucasian populations. This study defines the general applicability of the models for Chinese patients with nonmetastatic renal cell carcinoma treated with nephrectomy. The Kattan model was found to be the most accurate. The Cindolo model performed well in some situations, although only including clinical presentation and size of tumor. Therefore, models should be chosen according to different environments and purposes.