Validation of Prognostic Models for Renal Cell Carcinoma Recurrence, Cancer Specific Mortality and All-Cause Mortality.

Post-operative prognostic tools allow for improved prediction of future recurrence risk, patient counselling, assessment of eligibility for adjuvant treatments, and ensure appropriate follow-up surveillance. The purpose of this analysis is to validate existing prognostic models for patients with kidney cancer.

The Canadian Kidney Cancer Information System (CKCis) is a prospective cohort of patients managed at 14 institutions since January 1, 2011, to present. CKCis was used to assess 15 predictive models for kidney cancer recurrence, 6 for cancer specific mortality, and 4 for all-cause mortality in patients with a solitary, non-metastatic kidney tumor treated with surgery (partial or radical nephrectomy). Discrimination was measured using c-statistics, 5-year calibration plots for calibration, and decision curve analysis at 5-years post-surgery for net-benefit when considering adjuvant therapy.

7,174 patients were included. For kidney cancer recurrence, c-statistics ranged from 0.62 to 0.83, depending on whether the model was derived, and applied, to all patients without further stratification, specific risk groups, or to specific histological subtypes. Cancer specific mortality models had c-statistics ranging from 0.60 to 0.89 and all-cause mortality models from 0.60 to 0.73. Using decision curve analysis in clear-cell patients, the best models for choosing adjuvant therapy to prevent recurrence and cancer-related death were the Mayo Clinic prediction models.

Model performance varied considerably with some suitable for clinical use. If using prediction models to select adjuvant therapy, the Mayo Clinic models were best when applied to a large contemporary cohort of Canadian patients.

The performance of kidney cancer predictive models varied greatly when applied to a large contemporary cohort. We identified the most accurate models to use when counseling patients about prognosis and adjuvant therapy.

The Journal of urology. 2024 Dec 02 [Epub ahead of print]

Anita Robert, Ranjeeta Mallick, Daniel I McIsaac, Luke T Lavallée, Bimal Bhindi, Daniel Heng, Lori A Wood, Ricardo Rendon, Simon Tanguay, Anthony Finelli, Rahul K Bansal, Aly-Khan Lalani, Naveen Basappa, Miles P Mannas, Jasmir G Nayak, Georg A Bjarnason, Jean-Baptiste Lattouf, Frédéric Pouliot, Patrick O Richard, Camilla Tajzler, Rodney H Breau

School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada., Departments of Anesthesiology & Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada., Division of Urology, University of Ottawa, Ottawa, Ontario; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada., Division of Urology, University of Calgary, Calgary, Alberta, Canada., Division of Medical Oncology, University of Calgary, Calgary, Alberta, Canada., Division of Medical Oncology, QEII Health Sciences Center, Halifax, Nova Scotia, Canada., Department of Urology, Dalhousie University, Halifax, NS, Canada., Division of Urology, McGill University, Montreal, QC, Canada., Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, ON, Canada., Division of Urology, McMaster Institute of Urology, McMaster University, Hamilton, Ontario, Canada., Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada., Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada., Urologic Sciences, The University of British Columbia, Vancouver, BC, Canada; Vancouver Prostate Centre, Vancouver, BC, Canada., Section of Urology, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.; Men's Health Clinic Manitoba, Winnipeg, MB, Canada., Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada., Department of Surgery, University of Montreal, Montreal, Quebec, Canada., Division of Urology, CHU of Québec and Laval University, Quebec City, Quebec, Canada., Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec Canada., Ri-MUHC, McGill University, Montreal, Quebec, Canada., Division of Urology, University of Ottawa, Ottawa, Ontario; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.