Stefan Zastrow1,2, Laura-Maria Krabbe3, Ingmar Wolff4, Umberto Capitanio5,6, Tobias Klatte7, Thorsten Ecke8, Nina Huck9, Hendrik Borgmann10, Anna Scavuzzo11, Luca Cindolo12, Luigi Schips13, Cristian Surcel14, Cristian Mirvald14, Antoni Vilaseca Cabo15, Mireia Musquera15, Georg Hutterer16, Kristyna Prochazkova17, Christian Stief18, Manfred Wirth19,20, Matthias May21, Sabine Brookman-May18. 1. Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany. stefzastrow@me.com. 2. Department of Urology, Elblandklinikum Riesa, Weinbergstrasse 8, 01589, Riesa, Germany. stefzastrow@me.com. 3. Department of Urology, University Hospital Muenster, Muenster, Germany. 4. Department of Urology, University Hospital Greifswald, Greifswald, Germany. 5. Department of Urology, San Raffaele Scientific Institute, Milan, Italy. 6. Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy. 7. Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK. 8. Department of Urology, Hospital Bad Saarow, Bad Saarow, Germany. 9. Department of Urology, University Hospital Mannheim, Mannheim, Germany. 10. Department of Urology, University Hospital Mainz, Mainz, Germany. 11. Department of Urology, Instituto Nacional de Cancerologia-INCan, Mexico City, Mexico. 12. Department of Urology, ASL Abruzzo2, "S. Pio da Pietrelcina" Hospital, Vasto, Italy. 13. Department of Urology, ASL Abruzzo2, Chieti, Italy. 14. Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania. 15. Hospital Clínic, University of Barcelona, Barcelona, Spain. 16. Department of Urology, Medical University of Graz, Graz, Austria. 17. Department of Urology, Faculty of Medicine, Charles University, Pilsen, Czech Republic. 18. Department of Urology, LMU Munich, Grosshadern, Munich, Germany. 19. Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany. 20. Department of Urology, Elblandklinikum Riesa, Weinbergstrasse 8, 01589, Riesa, Germany. 21. Department of Urology, Klinikum St. Elisabeth, Straubing, Germany.
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.
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.
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