Kattan postoperative nomogram for renal cell carcinoma: Predictive accuracy in a Japanese population

Abstract

Objectives:The aim of the current study was to establish the predictive accuracy of the Kattan postoperative nomogram for non-metastatic renal cell carcinoma (RCC) in a Japanese population. Methods: A total of 211 patients with stage T1-3N0M0 clear cell RCC who underwent radical nephrectomy or nephronsparing surgery between 1991 and 2004 were included in this analysis. Median follow up was 81 months (range: 4-208). Univariate and multivariate analyses were performed , and the influence of age, sex, clinical presentation, T stage, histological tumor size, grade, and microvascular invasion on disease recurrence-free survival (RFS) was determined. For each patient, the prognostic score for 5-year RFS was calculated using the Kattan nomogram. The discriminating ability of this model was assessed by the concordance index, and bootstrapping was used to evaluate confidence intervals. Results:The 5-year RFS rate for all patients calculated using the Kaplan-Meier method was 80.6%. In multivariate analysis, the statistically significant prognostic factors for 5-year RFS were high-grade tumors (P = 0.019) and symptomatic disease (P = 0.017). The concordance index for RFS predicted by the Kattan nomogram was 0.735 (95% confidence interval: 0.734-0.736). There was a slight discrepancy between the RFS predicted by the Kattan nomogram and the likelihood of being recurrence-free at 5 years according to the Cox analysis in the current patient population. Conclusion: These findings suggest the necessity of constructing a more useful nomogram for predicting the prognosis of Japanese patients with non-metastatic RCC.

The Clinicopathological Risk Factors in Renal Cell Cancer for the Oncological Outcomes Following Nephron-Sparing Surgery: A PRISMA Systematic Review and Meta-Analysis

“…However, most studies investigating the prognosis predictors for RCC following NSS are restricted by single-center design, small sample size, or ethnic differences. For example, the Kattan nomogram has low predictive accuracy in French (36) and Japanese patients (37). Therefore, the precision of the models may be unsatisfactory, and the proposed nomograms still need to be externally validated before clinical application.…”

Can the Kattan nomogram still accurately predict prognosis in renal cell carcinoma using the revised 2010 tumor–nodes–metastasis reclassification?

“…Because the Kattan nomogram algorithm includes a comprehensive set of parameters for calculation of risk that include patient symptoms and pathology, it is widely used , and has been externally validated and compared with other prognostic models. 3,6,8,13 However, despite being widely used and validated , the Kattan nomogram can have poor predictive ability in some population groups, as reported in a cohort of French and Japanese patients. 7,10 These differences clearly emphasize the need for strict criteria for model assessment and ensuring validation in local population cohorts.…”

312 Accuracy capabilities comparisons between Karakiewicz, Kattan and Cindolo nomograms in predicting outcomes for renal cancer carcinoma: A systematic review and meta-analysis

“…1). 1,4,6,7,9,[14][15][16][17][18][19][20][21][22][23][24] In total, the preoperative Karakiewicz nomogram, postoperative Karakiewicz nomogram, Kattan nomogram, and the Cindolo nomogram were validated in 12 065, 12 868, 6036 and 4045 patients, respectively. In all of the included models, we did not observe any publication bias as assessed by the Begg's and Egger's methods (Fig.…”

“…9 When applied to external populations in Europe, the original Kattan nomogram has shown variable prognostic accuracy ranging from 61% to 81%. 4,[18][19][20][21]23 In 2007, Karakiewicz and colleagues attempted to improve on the accuracy of the aforementioned models by including more variables that have traditionally been shown to predict survival among patients with RCC. The cohort on which the model was developed included over 2500 patients with various stages of RCC treated at 5 different centres.…”