Predicting the 3-year tumor-specific survival in patients with T3a non-metastatic renal cell carcinoma
10.19723/j.issn.1671-167X.2024.04.021
- VernacularTitle:非转移性T3a肾细胞癌患者3年肿瘤特异性生存期预测
- Author:
Zezhen ZHOU
1
;
Shaohui DENG
;
Ye YAN
;
Fan ZHANG
;
Yichang HAO
;
Liyuan GE
;
Hongxian ZHANG
;
Guo-Liang WANG
;
Shudong ZHANG
Author Information
1. 北京大学第三医院泌尿外科,北京 100191
- Keywords:
Renal cell carcinoma;
Nomograms;
Prognosis
- From:
Journal of Peking University(Health Sciences)
2024;56(4):673-679
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To predict the 3-year cancer-specific survival(CSS)of patients with non-meta-static T3a renal cell carcinoma after surgery.Methods:A total of 336 patients with pathologically con-firmed T3a N0-1M0 renal cell carcinoma(RCC)who underwent surgical treatment at the Department of Urology,Peking University Third Hospital from March 2013 to February 2021 were retrospectively collect-ed.The patients were randomly divided into a training cohort of 268 cases and an internal validation co-hort of 68 cases at an 4∶1 ratio.Using two-way Lasso regression,variables were selected to construct a nomogram for predicting the 3-year cancer-specific survival(CSS)of the patients with T3aN0-1M0 RCC.Performance assessment of the nomogram included evaluation of discrimination and calibration ability,as well as clinical utility using measures such as the concordance index(C-index),time-dependent area un-der the receiver operating characteristic curve[time-dependent area under the curve(AUC)],calibra-tion curve,and decision curve analysis(DCA).Risk stratification was determined based on the nomo-gram scores,and Kaplan-Meier survival analysis and Log-rank tests were employed to compare progres-sion-free survival(PFS)and cancer-specific survival(CSS)among the patients in the different risk groups.Results:Based on the Lasso regression screening results,the nomogram was constructed with five variables:tumor maximum diameter,histological grading,sarcomatoid differentiation,T3a feature,and lymph node metastasis.The baseline data of the training and validation sets showed no statistical differences(P＞0.05).The consistency indices of the column diagram were found to be 0.808(0.708-0.907)and 0.903(0.838-0.969)for the training and internal validation sets,respectively.The AUC values for 3-year cancer-specific survival were 0.843(0.725-0.961)and 0.923(0.844-1.002)for the two sets.Calibration curves of both sets demonstrated a high level of consistency between the actual CSS and predicted probability.The decision curve analysis(DCA)curves indicated that the column dia-gram had a favorable net benefit in clinical practice.A total of 336 patients were included in the study,with 35 cancer-specific deaths and 69 postoperative recurrences.According to the line chart,the patients were divided into low-risk group(scoring 0-117)and high-risk group(scoring 119-284).Within the low-risk group,there were 16 tumor-specific deaths out of 282 cases and 36 postoperative recurrences out of 282 cases.In the high-risk group,there were 19 tumor-specific deaths out of 54 cases and 33 post-operative recurrences out of 54 cases.There were significant differences in progression-free survival(PFS)and cancer-specific survival(CSS)between the low-risk and high-risk groups(P＜0.000 1).Conclusion:A nomogram model predicting the 3-year CSS of non-metastatic T3a renal cell carcinoma patients was successfully constructed and validated in this study.This nomogram can assist clinicians in accurately assessing the long-term prognosis of such patients.
