Following surgery for non-metastatic renal cell carcinoma (RCC) with tumor thrombus, the risk of recurrence is significant but variable among individual patients. The purpose of this study is to develop and validate a predictive nomogram for individual estimation of recurrence risk following surgery for RCC with venous tumor thrombus.
Comprehensive data was collected for non-metastatic RCC patients with thrombus treated at 5 institutions from 2000-2013. Independent predictors of RCC recurrence from a competing risks analysis were developed into a nomogram. Predictive accuracy was compared between development/ validation cohorts and between the nomogram, the UCLA Integrated Staging System (UISS), SSIGN and Sorbellini models.
A total of 636 patients were analyzed (development cohort n=465, validation cohort n=171). Independent predictors (tumor diameter, BMI, Preoperative hemoglobin < lower limit of normal, thrombus level, perinephric fat invasion, and non-clear cell histology) were developed into a nomogram. Estimated 5-year recurrence free survival (RFS) was 49% overall. The 5 year RFS for patients with 0, 1, 2, >2 risk factors was 77%, 53%, 47%, and 20% respectively. Predictive accuracy was similar in development and validation cohorts (AUC 0.726 and 0.724). Predictive accuracy for the thrombus nomogram was higher than the UISS (AUC 0.726 vs. 0.595, p=0.001), SSIGN (AUC 0.713 vs. 0.612, p =0.04) or the Sorbellini models (AUC 0.709 vs. 0.638, p=0.02).
A predictive nomogram for postoperative recurrence in non-metastatic RCC patients with venous thrombus is presented. Improving individual post-operative risk assessment may allow better design and analysis of future adjuvant clinical trials.
The Journal of urology. 2017 Apr 11 [Epub ahead of print]
E Jason Abel, Timothy A Masterson, Jose A Karam, Viraj A Master, Vitaly Margulis, Ryan Hutchinson, C Adam Lorentz, Evan Bloom, Tyler M Bauman, Christopher G Wood, Michael L Blute
Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison WI. Electronic address: ., Department of Urology, Indiana University School of Medicine., Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas., Department of Urology, Emory University School of Medicine., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX., Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison WI.