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External validation of a postoperative nomogram for the prediction of disease-specific survival in patients with papillary renal cell carcinoma using a large multicenter database

  • Stefan ZastrowEmail author
  • Laura-Maria Krabbe
  • Ingmar Wolff
  • Umberto Capitanio
  • Tobias Klatte
  • Thorsten Ecke
  • Nina Huck
  • Hendrik Borgmann
  • Anna Scavuzzo
  • Luca Cindolo
  • Luigi Schips
  • Cristian Surcel
  • Cristian Mirvald
  • Antoni Vilaseca Cabo
  • Mireia Musquera
  • Georg Hutterer
  • Kristyna Prochazkova
  • Christian Stief
  • Manfred Wirth
  • Matthias May
  • Sabine Brookman-May
Original Article
  • 55 Downloads

Abstract

Purpose

Based on data retrieved from a comprehensive multicenter database, we externally validated a published postoperative nomogram for the prediction of disease-specific survival (DSS) in patients with papillary renal cell carcinoma (papRCC).

Methods

A multicenter database containing data of 2325 patients with surgically treated papRCC was used as validation cohort. After exclusion of patients with missing data and patients included in the development cohort, 1372 patients were included in the final analysis. DSS-probabilities according to the nomogram were calculated and compared to actual DSS-probabilities. Subsequently, calibration plots and decision curve analyses were applied.

Results

The median follow-up was 38 months (IQR 11.8–80.7). Median DSS was not reached. The c-index of the nomogram was 0.71 (95% CI 0.60–0.83). A sensitivity analysis including only patients operated after 1998 delivered a c-index of 0.84 (95% CI 0.77–0.92). Calibration plots showed slight underestimation of nomogram-predicted DSS in probability ranges below 90%: median nomogram-predicted 5-year DSS in the range below 90% was 55% (IQR 20–80), but the median actual 5-year DSS in the same group was 58% (95% CI 52–65). Decision-curve analysis showed a positive net-benefit for probability ranges between a DSS probability of 5% and 85%.

Conclusions

The nomogram performance was satisfactory for almost all DSS probabilities; hence it can be recommended for application in clinical routine and for counseling of patients with papRCC.

Keywords

Renal cell carcinoma Papillary Prognosis Nomogram 

Notes

Acknowledgements

We thank Wilma Erhardt, M.Sc. for the statistical review and support of this work.

Compliance with ethical standards

Conflict of interest

Stefan Zastrow declares that there are no conflicts of interest. Laura-Maria Krabbe declares that there are no conflicts of interest. Ingmar Wolff declares that there are no conflicts of interest. Umberto Capitanio declares that there are no conflicts of interest. Tobias Klatte declares that there are no conflicts of interest. Thorsten Ecke declares that there are no conflicts of interest. Nina Huck declares that there are no conflicts of interest. Hendrik Borgmann declares that there are no conflicts of interest. Anna Scavuzzo declares that there are no conflicts of interest. Luca Cindolo declares that there are no conflicts of interest. Luigi Schips declares that there are no conflicts of interest. Cristian Surcel declares that there are no conflicts of interest. Cristian Mirvald declares that there are no conflicts of interest. Antoni Vilaseca Cabo declares that there are no conflicts of interest. Mireia Musquera declares that there are no conflicts of interest. Georg Hutterer declares that there are no conflicts of interest. Kristyna Prochazkova declares that there are no conflicts of interest. Christian Stief declares that there are no conflicts of interest. Manfred Wirth declares that there are no conflicts of interest. Matthias May declares that there are no conflicts of interest. Sabine Brookman-May declares that there are no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Human and animal rights statement

This article does not contain any studies with animals performed by any of the authors.

Supplementary material

10147_2019_1530_MOESM1_ESM.xlsx (10 kb)
Supplementary Appendix, Table 2: Comparison of available tumor characteristics between excluded patients and patients within the validation cohort 1 (XLSX 9 kb)

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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Stefan Zastrow
    • 1
    • 19
    Email author
  • Laura-Maria Krabbe
    • 2
  • Ingmar Wolff
    • 3
  • Umberto Capitanio
    • 4
    • 5
  • Tobias Klatte
    • 6
  • Thorsten Ecke
    • 7
  • Nina Huck
    • 8
  • Hendrik Borgmann
    • 9
  • Anna Scavuzzo
    • 10
  • Luca Cindolo
    • 11
  • Luigi Schips
    • 12
  • Cristian Surcel
    • 13
  • Cristian Mirvald
    • 13
  • Antoni Vilaseca Cabo
    • 14
  • Mireia Musquera
    • 14
  • Georg Hutterer
    • 15
  • Kristyna Prochazkova
    • 16
  • Christian Stief
    • 17
  • Manfred Wirth
    • 1
    • 19
  • Matthias May
    • 18
  • Sabine Brookman-May
    • 17
  1. 1.Department of UrologyUniversity Hospital “Carl Gustav Carus”, Technische Universität DresdenDresdenGermany
  2. 2.Department of UrologyUniversity Hospital MuensterMuensterGermany
  3. 3.Department of UrologyUniversity Hospital GreifswaldGreifswaldGermany
  4. 4.Department of UrologySan Raffaele Scientific InstituteMilanItaly
  5. 5.Division of Experimental Oncology/Unit of Urology, URIIRCCS San Raffaele HospitalMilanItaly
  6. 6.Department of Urology, Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK
  7. 7.Department of UrologyHospital Bad SaarowBad SaarowGermany
  8. 8.Department of UrologyUniversity Hospital MannheimMannheimGermany
  9. 9.Department of UrologyUniversity Hospital MainzMainzGermany
  10. 10.Department of UrologyInstituto Nacional de Cancerologia-INCanMexico CityMexico
  11. 11.Department of UrologyASL Abruzzo2, “S. Pio da Pietrelcina” HospitalVastoItaly
  12. 12.Department of UrologyASL Abruzzo2ChietiItaly
  13. 13.Centre of Urological Surgery, Dialysis and Renal TransplantationFundeni Clinical InstituteBucharestRomania
  14. 14.Hospital ClínicUniversity of BarcelonaBarcelonaSpain
  15. 15.Department of UrologyMedical University of GrazGrazAustria
  16. 16.Department of Urology, Faculty of MedicineCharles UniversityPilsenCzech Republic
  17. 17.Department of UrologyLMU MunichGrosshadern, MunichGermany
  18. 18.Department of UrologyKlinikum St. ElisabethStraubingGermany
  19. 19.Department of UrologyElblandklinikum RiesaRiesaGermany

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