SUO 2017: Validation of The Preoperative Nomogram Predicting 12-Year Probability of Metastatic Renal Cancer

Washington, DC ( Dr. Ghanaat and colleagues presented their validation of a preoperative nomogram predicting 12-year probability of metastatic renal cancer. The authors previously published a predictive model to determine the preoperative risk of metastatic recurrence in localized renal cell carcinoma [1], as size of the primary renal mass, evidence of lymphadenopathy or necrosis on preoperative imaging and the mode of presentation were important predictors for the subsequent development of metastases. The objective of this study was to validate this initial nomogram and interrogate the additive value of somatic mutations in a subcohort with available genomic data. 

The authors conducted a retrospective review of all non-metastatic patients at Memorial Sloan Kettering Cancer Center from 2004-2011 who underwent a surgical extirpation for a renal mass (n=2,391). Mutations in VHL, PBRM1, SETD2, BAP1, KDM5C for those patients who had genomic analysis by previously described MSK IMPACT were recorded. Nomogram for 12-year metastasis free survival as previously described [1] was validated using Kaplan-Meier estimates. Associations between covariates and time to metastasis were calculated by Cox regression. A cohort of 281 patients was available for analysis. Median age at time of surgery was 61 (25-84) years. There were 33 patients who developed metastatic disease, with a median follow-up of 9 years. Associations between the five preoperative characteristics and time to metastasis were similar to the original report (male gender, mode of presentation, lymphadenopathy, necrosis, and increasing tumor size). The linear predictor from the nomogram was highly associated with metastasis free survival (p<0.0001). The authors then split the predicted 12-year metastasis free probability into quartiles, and used them to calculate the estimated 12-year survival in this cohort: it was not estimable in the first quartile, and 37.5%, 71% and 92% in 2nd, 3rd and 4th quartile, respectively indicating good calibration of the original nomogram. KDM5C was significantly associated with metastasis-free survival and remained significant after incorporating nomogram prediction into the model (HR=3.6, 95%CI 1.05-12.4, p = 0.04).

The authors concluded that on univariate assessment of factors in their original model are associated with metastatic recurrence. Further statistical analysis of the complete cohort and integration of genomic data is ongoing.


1. Raj GV, Thompson RH, Leibovich BC, et al. Preoperative nomogram predicting 12-year probability of metastatic renal cancer. J Urol 2008;179(6):2146-2151.

Presented by: Mazyar Ghanaat, BS, MD¹

Co-Authors: Cihan Duzgol MD², Kyle Blum MD¹, Mahyar Kashan ¹, Alejandro Sanchez MD¹, Renzo DiNatale MD¹, Maria Becerra MD¹, Buddima Ranasinghe MD¹, Nicole Benfante ¹, Jonathan Coleman MD¹, Michael W. Kattan PhD³, Paul Russo, MD¹, Oguz Akin MD², Irina Ostrovnaya PhD⁴ and Ar. Ari Hakimi MD¹

Affiliation: ¹Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.; ²Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA; ³Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA; ⁴Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA.

Written by: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC