The Karakiewicz nomogram is the most useful clinical predictor for survival outcomes in patients with localized renal cell carcinoma

Abstract

BACKGROUND: Outcomes after surgical removal of localized renal cell carcinoma (RCC) are variable. There have been multiple prognostic nomograms and risk groups developed for estimation of survival outcomes, with different models in use for evaluating patient eligibility in ongoing trials of adjuvant therapy. The authors aimed to establish the most useful prognostic model for patients with localized RCC to guide trial design, biomarker research, and clinical counseling. METHODS: A total of 390 consecutive patients who underwent nephrectomy for sporadic localized RCC in a tertiary institution (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) with 65 months median follow-up were retrospectively evaluated. The Karakiewicz nomogram, the Kattan nomogram, the Sorbellini nomogram, and the Leibovich model were compared in predicting survival outcomes (overall survival, cancer-specific survival, and freedom from recurrence) using likelihood analysis, adequacy indices, decision curve analysis, calibration, and concordance indices. RESULTS: Overall, the Karakiewicz nomogram outperformed the Kattan nomogram, the Sorbellini nomogram, and the Leibovich model. Highly improved accuracy was seen using the Karakiewicz nomogram in survival prediction, using likelihood ratio analysis in bivariate models including the competing prognostic models. The Karakiewicz nomogram showed higher adequacy and concordance indices and improved clinical benefit relative to all other nomograms. All 4 models were reasonably calibrated. Exploratory comparisons of prespecified discretized Karakiewicz nomograms and the SORCE trial recruitment criteria (a discretized Leibovich model) of high-risk patients favored the discretized Karakiewicz nomograms. CONCLUSIONS: The Karakiewicz nomogram was shown to be superior to the other tested nomograms and risk groups in predicting survival outcomes in localized RCC. Routine integration of this model into trial design and biomarker research should be considered. Cancer 2011;117:5314-

Contemporary external validation of the Leibovich model for prediction of progression after radical surgery for clear cell renal cell carcinoma

“…The model proposed by Leibovich et al (L-score model) [12] was developed for clear cell renal cell carcinomas (CCRCC). Pichler et al attempted to externally validate this model [15], and it has been shown to be superior to the two other integrated staging systems mentioned above [16]. However, the model is now more than 10 years old and was developed based on data for radical nephrectomy from 1970 to 2000.…”

“…However, the model is now more than 10 years old and was developed based on data for radical nephrectomy from 1970 to 2000. In addition, in the validation studies, the inclusion periods reached relatively far back in time [15,16].…”

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.…”

External validation of the preoperative Karakiewicz nomogram in a large multicentre series of patients with renal cell carcinoma

“…The model relied on patient age, gender, mode of presentation, clinical tumor size, clinical stage of the primary tumor, and presence of distant metastases and showed optimal model discrimination. Since its first external validation performed on a cohort of 1,972 patients [6], only one study further tested the predictive accuracy of this nomogram [7], showing its superiority compared with the other tested nomograms and risk groups in predicting survival outcomes in 390 patients with localized RCC.…”