Development and validation of prognostic nomograms for adult with papillary renal cell carcinoma: A retrospective study

Guo, Qingxiang; Li, Sai; Zhu, Jiawei; Wang, Zewei; Li, Zhen; Wang, Junqi; Wen, Rumin; Li, Hailong

doi:10.1016/j.clinsp.2024.100374

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Sumário

Original articles • Clinics 79 • 2024 • https://doi.org/10.1016/j.clinsp.2024.100374 copy

Development and validation of prognostic nomograms for adult with papillary renal cell carcinoma: A retrospective study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

Radiotherapy benefits prognosis in papillary renal cell carcinoma.
A precise nomogram predicts survival in pRCC patients.
External validation confirms the nomogram's applicability to Chinese pRCC.

Abstract

Objective

The aim of the study was to create two consensus nomograms for predicting Overall Survival (OS) and Cancer-Specific Survival (CSS) in adults with papillary Renal Cell Carcinoma (pRCC).

Methods

Using the Surveillance, Epidemiology, and End Results databases, a retrospective analysis of 1,074 adults with pRCC from 2004 to 2015 was performed. These patients were then randomly divided into two independent cohorts with a ratio of 7:3 (training cohort: 752; validation cohort: 322). In a retrospective analysis of 752 patients from the training cohort, independent prognostic variables affecting OS and CSS were found. R software was used to create prognostic nomograms based on the findings of Cox regression analysis. The performance of the nomograms was assessed using the Concordance Index (C-index), the Area Under Curve (AUC), a calibration curve, and Decision Curve Analysis (DCA). Data from the 107 postoperative pRCC patients at the Affiliated Hospital of Xuzhou Medical University were used for external validation of the nomogram.

Results

For OS and CSS, the C-indices and AUCs of the training cohort and the validation cohort indicated that the model had excellent discrimination. The DCA demonstrated that the model was clinically applicable, and the calibration curves in the internal and external validations showed that the model's accuracy was high.

Conclusion

The authors developed and validated a prognostic nomogram that accurately predicted the 3-, 5-, and 8-year OS and CSS of adults with pRCC. Clinicians can use this knowledge to direct the clinical management and counseling of patients with pRCC.

Keywords
Nomogram; Seer; Papillary renal cell carcinoma; Survival Analysis

Variables	Total (n = 1074)	Training set, n = 752 (70 %)	Validation set, n = 322 (30 %)	p
Age of diagnosis	61 (53.0‒70.00)	61 (53.5‒70.50)	62 (53.0‒70.0)	0.845
Race				0.305
White	880 (81.9 %)	619 (82.3 %)	261 (81.1 %)
Non-White	194 (18.1 %)	133 (17.7 %)	61 (18.9 %)
Sex				0.584
Female	321 (29.9 %)	221 (29.4 %)	100 (31.1 %)
Male	753 (70.1 %)	531 (70.6 %)	222 (68.9 %)
Marital status				0.961
Married	720 (67.0 %)	504 (67.0 %)	216 (67.1 %)
Single	161 (15.0 %)	114 (15.2 %)	47 (14.6 %)
Divorced/Wido-wed	193 (18.0 %)	134 (17.8 %)	59 (18.3 %)
Laterality				0.472
Left	565 (52.6 %)	401 (53.3 %)	164 (50.9 %)
Right	509 (47.4 %)	351 (46.7 %)	158 (49.1 %)
Months from diagnosis to treatment				0.906
< 1	621 (57.8 %)	435 (57.8 %)	186 (57.8 %)
1‒2	303 (28.2 %)	210 (27.9 %)	93 (28.9 %)
> 2	150 (14.0 %)	107 (14.2 %)	43 (13.4 %)
T Stage				0.222
T1	184 (17.1 %)	139 (18.5 %)	45 (14.0 %)
T2	129 (12.0 %)	93 (12.4 %)	36 (11.2 %)
T3	573 (53.4 %)	388 (51.6 %)	185 (57.5 %)
T4	188 (17.5 %)	132 (17.6 %)	56 (17.4 %)
N Stage				0.062
N0	761 (70.9 %)	550 (73.1 %)	211 (65.5 %)
N1	171 (15.9 %)	109 (14.5 %)	62 (19.3 %)
N2	115 (10.7 %)	72 (9.6 %)	43 (13.4 %)
Nx	27 (2.5 %)	21 (2.8 %)	6 (1.9 %)
M Stage				0.145
M0	651 (60.6 %)	451 (60.0 %)	200 (62.1 %)
M1	418 (38.9 %)	296 (39.4 %)	122 (37.9 %)
Mx	5 (0.5 %)	5 (0.6 %)	0 (0.0 %)
AJCC Stage				0.198
Ⅰ	144 (13.4 %)	109 (14.5 %)	35 (10.9 %)
Ⅱ	78 (7.3 %)	54 (7.2 %)	24 (7.5 %)
Ⅲ	313 (29.1 %)	207 (27.5 %)	106 (32.9 %)
Ⅳ	539 (50.2 %)	382 (50.8 %)	157 (48.8 %)
Grade				0.995
Ⅰ	16 (1.5 %)	11 (1.5 %)	5 (1.6 %)
Ⅱ	45 (4.2 %)	31 (4.1 %)	14 (4.3 %)
Ⅲ	188 (17.5 %)	134 (17.8 %)	54 (16.8 %)
Ⅳ	631 (58.8 %)	441 (58.6 %)	190 (59.0 %)
Unknow	194 (18.1 %)	135 (18.0 %)	59 (18.3 %)
Tumor Size	90 (61-123)	90 (60-120)	90 (62-126)	0.755
Operation				0.176
Partial	85 (7.9 %)	65 (8.6 %)	20 (6.2 %)
Radical	989 (92.1 %)	687 (91.4 %)	302 (93.8 %)
Radiation				0.709
No	927 (86.3 %)	651 (86.6 %)	276 (85.7 %)
Yes	147 (13.7 %)	101 (13.4 %)	46 (14.3 %)
Chemotherapy				0.293
No/Unknown	748 (69.6 %)	531 (70.6 %)	217 (67.4 %)
Yes	326 (30.4 %)	221 (29.4 %)	105 (32.6 %)
Median annual family income, (median US dollars*)				0.370
< 35,000	16 (1.5 %)	11 (1.5 %)	5 (1.6 %)
35,000‒75,000	756 (70.4 %)	539 (71.7 %)	217 (67.4 %)
> 75,000	302 (28.1 %)	202 (26.9 %)	100 (31.1 %)

Variables	Univariate analyses hazard ratios (95 % CI)	p	Multivariate analyses hazard ratios (95 % CI)	p
Age of diagnosis
≤ 45	Ref.		Ref.
46-72	1.46 (1.08, 1.96)	0.012	1.45 (1.06, 1.96)	0.018
≥ 73	1.88 (1.35, 2.61)	<0.001	2.30 (1.63, 3.23)	<0.001
Race
White	Ref.
Non-White	1.04 (0.74, 1.45)	0.831
Sex
Female	Ref.
Male	1.15 (0.96, 1.37)	0.129
Marital status
Married	Ref.
Single	0.91 (0.72, 1.15)	0.429
Divorced/Widowed	1.10 (0.89, 1.35)	0.399
Laterality
Left	Ref.		Ref.
Right	0.84 (0.71, 0.98)	0.030	0.93 (0.79, 1.10)	0.400
Median annual family income, (median US dollars*)
< 35,000	Ref.
35,000‒75,000	0.49 (0.27, 0.89)	0.484
> 75,000	0.55 (0.30, 1.02)	0.057
Months from diagnosis to treatment
< 1	Ref.
1	1.34 (1.12, 1.61)	0.625
> 1	0.92 (0.72, 1.17)	0.479
T Stage
T1	Ref.		Ref.
T2	1.60 (1.14, 2.24)	0.006	1.35 (0.75, 2.44)	0.323
T3	2.92 (2.27, 3.77)	<0.001	1.90 (1.19, 3.04)	0.007
T4	5.38 (4.01, 7.21)	<0.001	2.80 (1.69, 4.65)	<0.001
N Stage
N0	Ref.		Ref.
N1	2.11 (1.68, 2.63)	<0.001	1.67 (1.31, 2.13)	<0.001
N2	2.60 (2.00, 3.37)	<0.001	1.57 (1.18, 2.09)	0.002
Nx	4.70 (3.00, 7.37)	<0.001	2.90 (1.75, 4.78)	<0.001
M Stage
M0	Ref.		Ref.
M1	2.49 (2.10, 2.94)	<0.001	1.48 (1.09, 2.01)	0.012
Mx	4.26 (1.75, 10.34)	0.001	0.78 (0.29, 2.12)	0.627
AJCC Stage
Ⅰ	Ref.		Ref.
Ⅱ	1.63 (1.05, 2.54)	0.031	0.95 (0.46, 1.95)	0.012
Ⅲ	2.77 (2.00, 3.83)	<0.001	1.12 (0.64, 1.95)	0.028
Ⅳ	5.79 (4.26, 7.87)	<0.001	1.45 (0.80, 2.63)	0.221
Grade
Ⅰ	Ref.		Ref.
Ⅱ	1.91 (0.55, 6.66)	0.308	1.99 (0.57, 7.00)	0.282
Ⅲ	4.70 (1.49, 14.83)	0.008	2.92 (0.92, 9.32)	0.070
Ⅳ	6.26 (2.01, 19.53)	0.002	3.25 (1.03, 10.26)	0.044
Unknown	5.14 (1.63, 16.21)	0.005	3.53 (1.11, 11.22)	0.033
Tumor Size (mm)
≤ 66	Ref.		Ref.
68‒120	1.80 (1.47, 2.20)	<0.001	1.16 (0.90, 1.49)	0.257
≥ 122	2.89 (2.30, 3.61)	<0.001	1.74 (1.31, 2.29)	<0.001
Surgery				0.119
Partial	Ref.		Ref.
Total	1.95 (1.40, 2.72)	<0.001	0.77 (0.53, 1.12)	0.166
Radiation
No	Ref.		Ref.
Yes	1.95 (1.55, 2.46)	<0.001	1.44 (1.13, 1.85)	0.004
Chemotherapy
No/Unknown	Ref.		Ref.
Yes	1.75 (1.46, 2.10)	<0.001	0.94 (0.77, 1.14)	0.514

Variables	Univariate analyses hazard ratios (95 % CI)	p	Multivariate analyses hazard ratios (95 % CI)	p
Age of diagnosis
≤ 62	Ref.
63‒70	1.35 (0.99, 1.84)	0.055
≥ 71	1.52 (1.08, 2.15)	0.017
Race
White	Ref.
Non-White	0.84 (0.63, 1.13)	0.491
Sex
Female	Ref.
Male	1.20 (0.99, 1.45)	0.070
Marital status
Married	Ref.
Single	0.84 (0.65, 1.09)	0.184
Divorced/Widowed	1.04 (0.83, 1.31)	0.709
Laterality
Left	Ref.
Right	0.85 (0.71, 1.01)	0.059
Median annual family income, (median US dollars*)
< 35,000	Ref.
35,000‒75,000	0.54 (0.28, 1.04)	0.065
> 75,000	0.64 (0.33, 1.25)	0.192
Months from diagnosis to treatment
< 1	Ref.
1	1.39 (1.14, 1.68)	0.107
> 1	0.86 (0.66, 1.12)	0.265
T Stage
T1	Ref.		Ref.
T2	1.99 (1.37, 2.89)	<0.001	1.25 (0.69, 2.27)	0.464
T3	3.53 (2.63, 4.74)	<0.001	1.77 (1.10, 2.86)	0.019
T4	6.40 (4.59, 8.93)	<0.001	2.43 (1.45, 4.09)	<0.001
N Stage
N0	Ref.		Ref.
N1	2.35 (1.86, 2.96)	<0.001	1.80 (1.40, 2.32)	<0.001
N2	2.78 (2.11, 3.65)	<0.001	1.57 (1.17, 2.11)	0.003
Nx	5.07 (3.20, 8.05)	<0.001	2.87 (1.71, 4.82)	<0.001
M Stage
M0	Ref.		Ref.
M1	2.83 (2.37, 3.38)	<0.001	1.54 (1.11, 2.12)	0.009
Mx	5.02 (2.06, 12.21)	<0.001	0.91 (0.33, 2.50)	0.860
AJCC Stage
Ⅰ	Ref.		Ref.
Ⅱ	2.27 (1.35, 3.81)	0.002	1.18 (0.54, 2.56)	0.685
Ⅲ	3.74 (2.50, 5.59)	<0.001	1.39 (0.75, 2.59)	0.045
Ⅳ	8.46 (5.76, 12.42)	<0.001	1.86 (0.96, 3.58)	0.001
Grade
Ⅰ	Ref.		Ref.
Ⅱ	2.36 (0.53, 10.56)	0.260	2.71 (0.60, 12.21)	0.196
Ⅲ	5.72 (1.41, 23.23)	0.015	3.43 (0.84, 14.06)	0.087
Ⅳ	7.96 (1.98, 32.00)	0.004	3.76 (0.93, 15.23)	0.064
Unknown	5.79 (1.43, 23.54)	0.014	3.86 (0.94, 15.80)	0.061
Tumor Size
≤ 90	Ref.		Ref.
91‒130	2.46 (1.90, 3.17)	<0.001	1.49 (1.10, 2.03)	0.010
≥ 131	4.13 (3.12, 5.47)	<0.001	2.30 (1.63, 3.23)	<0.001
Surgery				0.432
Partial	Ref.		Ref.
Total	2.33 (1.58, 3.44)	<0.001	0.75 (0.49, 1.16)	0.196
Radiation
No	Ref.		Ref.
Yes	1.95 (1.55, 2.46)	<0.001	1.49 (1.15, 1.92)	0.002
Chemotherapy
No/Unknown	Ref.		Ref.
Yes	1.75 (1.46, 2.10)	<0.001	0.96 (0.78, 1.19)	0.731

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[1] ⁎ Corresponding author. E-mail address:Justinlee719@163.com (H. Li)