Predictive Nomogram for Recurrence following Surgery for Nonmetastatic Renal Cell Cancer with Tumor Thrombus

No AccessJournal of UrologyAdult Urology1 Oct 2017Predictive Nomogram for Recurrence following Surgery for Nonmetastatic Renal Cell Cancer with Tumor Thrombus E. Jason Abel, Timothy A. Masterson, Jose A. Karam, Viraj A. Master, Vitaly Margulis, Ryan Hutchinson, C. Adam Lorentz, Evan Bloom, Tyler M. Bauman, Christopher G. Wood, and Michael L. Blute E. Jason AbelE. Jason Abel Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Financial interest and/or other relationship with Argos Therapeutics. More articles by this author , Timothy A. MastersonTimothy A. Masterson Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana More articles by this author , Jose A. KaramJose A. Karam Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas More articles by this author , Viraj A. MasterViraj A. Master Department of Urology, Emory University School of Medicine, Atlanta, Georgia More articles by this author , Vitaly MargulisVitaly Margulis Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author , Ryan HutchinsonRyan Hutchinson Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author , C. Adam LorentzC. Adam Lorentz Department of Urology, Emory University School of Medicine, Atlanta, Georgia More articles by this author , Evan BloomEvan Bloom Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin More articles by this author , Tyler M. BaumanTyler M. Bauman Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin More articles by this author , Christopher G. WoodChristopher G. Wood Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas Financial interest and/or other relationship with Pfizer, Argos, Novartis and Agenus. More articles by this author , and Michael L. BluteMichael L. Blute Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.04.066AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Following surgery for nonmetastatic renal cell carcinoma with tumor thrombus the risk of recurrence is significant but variable among patients. The purpose of this study was to develop and validate a predictive nomogram for individual estimation of recurrence risk following surgery for renal cell carcinoma with venous tumor thrombus. Materials and Methods: Comprehensive data were collected on patients with nonmetastatic renal cell carcinoma and thrombus treated at a total of 5 institutions from 2000 to 2013. Independent predictors of recurrent renal cell carcinoma from a competing risks analysis were developed into a nomogram. Predictive accuracy was compared between the development and validation cohorts, and between the nomogram and the UISS (UCLA Integrated Staging System, SSIGN (Stage, Size, Grade and Necrosis) and Sorbellini models. Results: A total of 636 patients were analyzed, including the development cohort of 465 and the validation cohort of 171. Independent predictors, including tumor diameter, body mass index, preoperative hemoglobin less than the lower limit of normal, thrombus level, perinephric fat invasion and nonclear cell histology, were developed into a nomogram. Estimated 5-year recurrence-free survival was 49% overall. Five-year recurrence-free survival in patients with 0, 1, 2 and more than 2 risk factors was 77%, 53%, 47% and 20%, respectively. Predictive accuracy was similar in the development and validation cohorts (AUC 0.726 and 0.724, respectively). Predictive accuracy of the thrombus nomogram was higher than that of the UISS (AUC 0.726 vs 0.595, p = 0.001), SSIGN (AUC 0.713 vs 0.612, p = 0.04) and Sorbellini models (AUC 0.709 vs 0.638, p = 0.02). Conclusions: We present a predictive nomogram for postoperative recurrence in patients with nonmetastatic renal cell carcinoma with venous thrombus. Improving individual postoperative risk assessment may allow for better design and analysis of future adjuvant clinical trials. References 1 : A critical analysis of surgery for kidney cancer with vena cava invasion. Eur Urol2007; 52: 658. Google Scholar 2 : Risk factors for recurrence after surgery in non-metastatic RCC with thrombus: a contemporary multicentre analysis. BJU Int2016; 117: E87. 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Link, Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySmith J (2017) This Month in Adult UrologyJournal of Urology, VOL. 198, NO. 4, (715-716), Online publication date: 1-Oct-2017. Volume 198Issue 4October 2017Page: 810-816Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsnomogramsrenal cellrisklocalkidney neoplasmscarcinomaneoplasm recurrenceMetricsAuthor Information E. Jason Abel Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Financial interest and/or other relationship with Argos Therapeutics. More articles by this author Timothy A. Masterson Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana More articles by this author Jose A. Karam Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas More articles by this author Viraj A. Master Department of Urology, Emory University School of Medicine, Atlanta, Georgia More articles by this author Vitaly Margulis Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author Ryan Hutchinson Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author C. Adam Lorentz Department of Urology, Emory University School of Medicine, Atlanta, Georgia More articles by this author Evan Bloom Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin More articles by this author Tyler M. Bauman Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin More articles by this author Christopher G. Wood Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas Financial interest and/or other relationship with Pfizer, Argos, Novartis and Agenus. More articles by this author Michael L. Blute Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin More articles by this author Expand All Advertisement PDF downloadLoading ...