The difficulty in selecting patients for cytoreductive nephrectomy: An evaluation of previously described predictive models

To externally evaluate a preoperative points system and a preoperative nomogram, both created to assess time to death after cytoreductive nephrectomy (CN). We identified 298 patients who underwent CN at our institution, a tertiary cancer center, between 1989 and 2015. To validate the points system,...

Full description

Saved in:
Bibliographic Details
Published in:Urologic oncology Vol. 35; no. 1; pp. 35.e1 - 35.e5
Main Authors: Manley, Brandon J., Tennenbaum, Daniel M., Vertosick, Emily A., Hsieh, James J., Sjoberg, Daniel D., Assel, Melissa, Benfante, Nicole E., Strope, Seth A., Kim, Eric, Casuscelli, Jozefina, Becerra, Maria F., Coleman, Jonathan A., Hakimi, Abraham Ari, Russo, Paul
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.01.2017
Subjects:
Aged
Carcinoma, Renal Cell - mortality
Carcinoma, Renal Cell - secondary
Carcinoma, Renal Cell - surgery
Cytoreduction Surgical Procedures - mortality
Decision Support Techniques
Diaphragm
Female
Follow-Up Studies
Humans
Kidney Neoplasms - mortality
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
L-Lactate Dehydrogenase - blood
Liver Neoplasms - mortality
Liver Neoplasms - secondary
Lymphatic Metastasis
Male
Middle Aged
Mortality
Neoplasm metastasis
Nephrectomy
Nephrectomy - methods
Nephrectomy - mortality
Nomograms
Patient Selection
Preoperative Period
Prognosis
Proportional Hazards Models
Renal cell carcinoma
Retroperitoneal Space
Risk Assessment - methods
Serum Albumin - metabolism
Survival Rate
Time Factors
Urology
Prognosis
Nephrectomy
Neoplasm metastasis
Renal cell carcinoma
Mortality
ISSN:1078-1439, 1873-2496, 1873-2496
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:To externally evaluate a preoperative points system and a preoperative nomogram, both created to assess time to death after cytoreductive nephrectomy (CN). We identified 298 patients who underwent CN at our institution, a tertiary cancer center, between 1989 and 2015. To validate the points system, we compared reported overall survival (OS) for each criterion to observed OS in our cohort. To evaluate the nomogram, we prognosticated risk of death at 6 months after surgery for 280 patients with sufficient follow-up in our cohort and evaluated discrimination using area under the curve (AUC) and calibration. Decision curve analysis was performed to assess clinical utility of the nomogram. Significant differences in OS were observed between patients with and without 5 of 7 criteria on univariate analysis: low albumin (P<0.0001), high lactate dehydrogenase (P = 0.002), liver metastasis (P = 0.004), retroperitoneal lymphadenopathy (P = 0.002), and supradiaphragmatic lymphadenopathy (P = 0.019). Discrimination from the preoperative model, predicting death within 6 months of surgery was lower in our cohort (AUC = 0.65, 95% CI: 0.52–0.79) than the original publication (AUC = 0.76). Decision curve analysis demonstrated little benefit for applicability. Five previously defined risk factors are predictive of decreased OS after CN in our cohort. We found lower discrimination using the preoperative model and minimal clinical utility according to decision analysis in our study cohort. These findings suggest the need for improved models to aid patient stratification and consequent treatment choice. •A total of 5 of 7 preoperative risk factors were predictive of overall survival.•The complete model had an AUC of 0.65; 95% (CI: 0.52–0.79) in our cohort.•Decision curve analysis demonstrated little benefit for applicability.•Differences in patient selection and pathology may explain the differentiating factors.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1078-1439
1873-2496
1873-2496
DOI:10.1016/j.urolonc.2016.07.010