scholarly journals Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

2020 ◽  
Author(s):  
Wenwen Zheng ◽  
Weiwei Zhu ◽  
Shengqiang Yu ◽  
Kangqi Li ◽  
Yuexia Ding ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Staging System ◽  
Seer Database ◽  
Ajcc Staging System ◽  
Ajcc Staging ◽  
Metastatic Rcc

Abstract Background: Heterogeneity of metastatic renal cell carcinoma (RCC) constraints accurate prognosis prediction of the tumor. We therefore aimed at developing a novel nomogram for accurate prediction of overall survival (OS) of patients with metastatic RCC.Methods: We extracted 2010 to 2016 data for metastatic RCC patients in the Surveillance, Epidemiology, and End Results (SEER) database, and randomly stratified them equally into training and validation sets. Prognostic factors for OS were analyzed using Cox regression models, and thereafter integrated into a 1, 3 and 5-year OS predictive nomogram. The nomogram was validated using the training and validation sets. The performance of this model was evaluated by the Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), category-free net reclassification improvement (NRI), index of prediction accuracy (IPA), and decision curve analysis (DCA).Results: Overall, 2315 metastatic RCC patients in the SEER database who fulfilled our inclusion criteria were utilized in constructing a nomogram for predicting OS of newly diagnosed metastatic RCC patients. The nomogram incorporated eight clinical factors: Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery and bone, brain, liver, and lung metastases, all significantly associated with OS. The model was superior to the American Joint Committee on Cancer (AJCC) staging system (7th edition) both in training (C-indices, 0.701 vs. 0.612, P<0.001) and validation sets (C-indices, 0.676 vs. 0.600, P<0.001). The calibration plots of the nomogram corresponded well between predicted and observed values. NRI, IDI, and IPA further validated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed reliable clinical application of our model in prognosis prediction of metastatic RCC patients.Conclusions: We developed and validated an accurate nomogram for individual OS prediction of metastatic RCC patients. This nomogram can be applied in design of clinical trials, patient counseling, and rationalizing therapeutic modalities.

scholarly journals Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wenwen Zheng ◽  
Weiwei Zhu ◽  
Shengqiang Yu ◽  
Kangqi Li ◽  
Yuexia Ding ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Staging System ◽  
Seer Database ◽  
Ajcc Staging System ◽  
Ajcc Staging ◽  
Metastatic Rcc

Abstract Background Heterogeneity of metastatic renal cell carcinoma (RCC) constraints accurate prognosis prediction of the tumor. We therefore aimed at developing a novel nomogram for accurate prediction of overall survival (OS) of patients with metastatic RCC. Methods We extracted 2010 to 2016 data for metastatic RCC patients in the Surveillance, Epidemiology, and End Results (SEER) database, and randomly stratified them equally into training and validation sets. Prognostic factors for OS were analyzed using Cox regression models, and thereafter integrated into a 1, 3 and 5-year OS predictive nomogram. The nomogram was validated using the training and validation sets. The performance of this model was evaluated by the Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), category-free net reclassification improvement (NRI), index of prediction accuracy (IPA), and decision curve analysis (DCA). Results Overall, 2315 metastatic RCC patients in the SEER database who fulfilled our inclusion criteria were utilized in constructing a nomogram for predicting OS of newly diagnosed metastatic RCC patients. The nomogram incorporated eight clinical factors: Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery and bone, brain, liver, and lung metastases, all significantly associated with OS. The model was superior to the American Joint Committee on Cancer (AJCC) staging system (7th edition) both in training (C-indices, 0.701 vs. 0.612, P < 0.001) and validation sets (C-indices, 0.676 vs. 0.600, P < 0.001). The calibration plots of the nomogram corresponded well between predicted and observed values. NRI, IDI, and IPA further validated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed reliable clinical application of our model in prognosis prediction of metastatic RCC patients. Conclusions We developed and validated an accurate nomogram for individual OS prediction of metastatic RCC patients. This nomogram can be applied in design of clinical trials, patient counseling, and rationalizing therapeutic modalities.

scholarly journals Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

2020 ◽  
Author(s):  
Wenwen Zheng ◽  
Weiwei Zhu ◽  
Shengqiang Yu ◽  
Kangqi Li ◽  
Yuexia Ding ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Staging System ◽  
Survival Prediction ◽  
Seer Database ◽  
Training Set ◽  
Ajcc Staging System ◽  
Validation Set ◽  
Ajcc Staging ◽  
Metastatic Rcc

Abstract Background: The prognosis of metastatic renal cell carcinoma (RCC) patients vary widely because of clinical and pathological heterogeneity. We aimed to develop a novel nomogram to predict overall survival (OS) for this population. Methods: Metastatic RCC patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. These patients were randomly assigned to a training set and a validation set at a ratio of 1:1. Significant prognostic factors of survival were identified through Cox regression models and then integrated to form a nomogram to predict 1-, 3- and 5-year OS. The nomogram was subsequently subjected to validations via the training and the validation sets. The performance of this model was evaluated by using Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Results: Overall, 2315 eligible metastatic RCC patients were enrolled from the SEER database. A nomogram of survival prediction for patients of newly diagnosed with metastatic RCC was established, in which eight clinical factors significantly associated with OS were involved, including Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery, bone metastasis, brain metastasis, liver metastasis, and lung metastasis. The new model presented better discrimination power than the American Joint Committee on Cancer (AJCC) staging system (7th edition) in the training set (C-indexes, 0.701 vs. 0.612, P <0.001) and the validation set (C-indexes, 0.676 vs. 0.600, P <0.001). The calibration plots of the nomogram exhibited optimal agreement between the predicted values and the observed values. The results of NRI and IDI also indicated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed higher clinical use of our model in survival prediction. Conclusions: We developed and validated an effective nomogram to provide individual OS prediction for metastatic RCC patients, which would be beneficial to clinical trial design, patient counseling, and therapeutic modality selection.

scholarly journals Development and Validation of a Nomogram to Predict Overall Survival for Patients with Metastatic Renal Cell Carcinoma

2020 ◽  
Author(s):  
Wenwen Zheng ◽  
Weiwei Zhu ◽  
Shengqiang Yu ◽  
Kangqi Li ◽  
Yuexia Ding ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Staging System ◽  
Survival Prediction ◽  
Seer Database ◽  
Training Set ◽  
Ajcc Staging System ◽  
Validation Set ◽  
Ajcc Staging ◽  
Metastatic Rcc

Abstract Background: The prognosis of metastatic renal cell carcinoma (RCC) patients vary widely because of clinical and pathological heterogeneity.We aimed to develop a novel nomogram to predict overall survival (OS) for this population.Methods: Metastatic RCC patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. These patients wererandomly assignedto a training set and a validation set at a ratio of 1:1. Significant prognostic factors of survival were identified through Cox regression models and then integrated to form a nomogram to predict 1-, 3- and 5-year OS. The nomogram was subsequently subjected to validationsvia the training and the validation sets. The performance of this model was evaluated by using Harrell’s concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Results: Overall, 2315 eligible metastatic RCC patients were enrolled from the SEER database. A nomogram of survival prediction for patients of newly diagnosed with metastatic RCC was established, in which eight clinical factors significantly associated with OS were involved, including Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery, bone metastasis, brain metastasis, liver metastasis, and lung metastasis.The new model presented better discrimination power than the American Joint Committee on Cancer (AJCC) staging system (7th edition) in the training set (C-indexes, 0.701 vs. 0.612, P<0.001) and the validation set (C-indexes, 0.675 vs. 0.600, P<0.001). The calibration plots of the nomogram exhibited optimal agreement between the predicted values and the observed values.The results of NRI and IDI also indicated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed higher clinical use of our model in survival prediction.Conclusions: We developed and validated an effective nomogram to provide individual OS prediction for metastatic RCC patients, which would be beneficial to clinical trial design, patient counseling, and therapeutic modality selection.

scholarly journals Sorafenib as a Second-Line Treatment in Metastatic Renal Cell Carcinoma in Mexico: A Prospective Cohort Study

2021 ◽  
Author(s):  
Ana Elena Martin-Aguilar ◽  
Haidé Nayeli Núñez-López ◽  
Juan C. Ramirez-Sandoval
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Line Treatment ◽  
Second Line ◽  
Sorafenib Treatment ◽  
Sequential Inhibition ◽  
Metastatic Rcc

Abstract Background: Sequential inhibition of the vascular endothelial growth factor (VEGF) pathway with sorafenib could be useful for patients with metastatic renal cell carcinoma (RCC). Our aim was to determine the activity and tolerability of sorafenib as a second-line therapy in advanced RCC initially treated with a different VEGF-tyrosine kinase inhibitor (TKI).Methods: A prospective observational cohort in Mexico (2012–2019). We included 132 subjects with metastatic RCC and who had progression despite treatment with sunitinib. The primary end-point was time to disease progression as evaluated every 12–16 weeks.Results: The mean age of the cohort was 59 years (interquartile range [IQR] 50-72), 96 (73%) were men, and 48 (36%) had a favorable prognosis according to the IMDC (International Metastatic RCC Database Consortium) prognostic model. The median progression-free survival (PFS) and overall-survival after the introduction of sorafenib treatment was 8.6 months (95% confidence interval [CI]: 6.7–10.5) and 40 months (95% CI: 34.5–45.4) respectively. The median overall survival from RCC diagnosis to death was 71 months (95% CI: 58.2–83.8). On multivariable analyses, age >65 years was associated with a longer PFS (HR 0.51; 95% CI: 0.31-0.86; p = 0.018). The median PFS in subjects aged >65 years was longer compared to subjects ≤65 years (14.0 [95% CI: 9.2–18.8] vs. 7.2 months [95% CI: 5.3–9.1]; p = 0.012). Adverse events grade ≥3 associated with sorafenib occurred in 38 (29%) patients.Conclusion: Sequential inhibition of VEGF with sorafenib as a second-line treatment may benefit patients with metastatic RCC, especially in subjects >65 years old.

scholarly journals Sorafenib as a second-line treatment in metastatic renal cell carcinoma in Mexico: a prospective cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ana Elena Martín-Aguilar ◽  
Haidé Núñez-López ◽  
Juan C. Ramirez-Sandoval
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Line Treatment ◽  
Second Line ◽  
Sorafenib Treatment ◽  
Sequential Inhibition ◽  
Metastatic Rcc

Abstract Background Sequential inhibition of the vascular endothelial growth factor (VEGF) pathway with sorafenib could be useful for patients with metastatic renal cell carcinoma (RCC). Our aim was to determine the activity and tolerability of sorafenib as a second-line therapy in advanced RCC initially treated with a different VEGF-tyrosine kinase inhibitor (TKI). Methods A prospective observational cohort in Mexico (2012–2019). We included 132 subjects with metastatic RCC and who had progression despite treatment with sunitinib. The primary end-point was time to disease progression as evaluated every 12–16 weeks. Results The mean age of the cohort was 59 years (interquartile range [IQR] 50–72), 96 (73%) were men, and 48 (36%) had a favorable prognosis according to the IMDC (International Metastatic RCC Database Consortium) prognostic model. The median progression-free survival (PFS) and overall-survival after the introduction of sorafenib treatment was 8.6 months (95% confidence interval [CI]: 6.7–10.5) and 40 months (95% CI: 34.5–45.4) respectively. The median overall survival from RCC diagnosis to death was 71 months (95% CI: 58.2–83.8). On multivariable analyses, age > 65 years was associated with a longer PFS (HR 0.51; 95% CI: 0.31–0.86; p = 0.018). The median PFS in subjects aged > 65 years was longer compared to subjects ≤65 years (14.0 [95% CI: 9.2–18.8] vs. 7.2 months [95% CI: 5.3–9.1]; p = 0.012). Adverse events grade ≥ 3 associated with sorafenib occurred in 38 (29%) patients. Conclusion Sequential inhibition of VEGF with sorafenib as a second-line treatment may benefit patients with metastatic RCC, especially in subjects > 65 years old.

scholarly journals Sorafenib as a Second-Line Treatment in Metastatic Renal Cell Carcinoma in Mexico: A Prospective Cohort Study

2020 ◽  
Author(s):  
Ana Elena Martin-Aguilar ◽  
Haidé Nayeli Núñez-López ◽  
Juan C. Ramirez-Sandoval
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Line Treatment ◽  
Second Line ◽  
Sorafenib Treatment ◽  
Sequential Inhibition ◽  
Metastatic Rcc

Abstract Background: Sequential inhibition of the vascular endothelial growth factor (VEGF) pathway with sorafenib could be useful for patients with metastatic renal cell carcinoma (RCC). Our aim was to determine the activity and tolerability of sorafenib as a second-line therapy in advanced RCC initially treated with a different VEGF-tyrosine kinase inhibitor (TKI).Methods: A prospective observational cohort in Mexico (2012–2019). We included 148 subjects with metastatic RCC and who had progression despite treatment with sunitinib (n = 144) or pazopanib (n = 4). The primary end-point was time to disease progression as evaluated every 12–16 weeks.Results: The mean age of the cohort was 58 years (interquartile range [IQR] 48-68), 104 (70%) were men, and 51 (35%) had a favorable prognosis according to the IMDC (International Metastatic RCC Database Consortium) prognostic model. The median progression-free survival (PFS) and overall-survival after the introduction of sorafenib treatment was 8.5 months (95% confidence interval [CI]: 6.8–10.2) and 40.1 months (95% CI: 35.2–45.0) respectively. The median overall survival from RCC diagnosis to death was 71 months (95% CI: 63.9–79.4). On multivariate analyses, age >65 years was associated with a longer PFS (HR 0.57; 95% CI: 0.35-0.93; p = 0.025). The median PFS in subjects aged >65 years was longer compared to subjects ≤65 years (14.0 [95% CI: 9.2–17.9] vs. 7.2 months [95% CI: 5.5–8.9]; p = 0.018). Adverse events grade ≥3 associated with sorafenib occurred in 42 (28%) patients.Conclusion: Sequential inhibition of VEGF with sorafenib as a second-line treatment may benefit patients with metastatic RCC, especially in subjects >65 years old.

scholarly journals Sorafenib as a Second-Line Treatment in Metastatic Renal Cell Carcinoma in Mexico: A Prospective Cohort Study

2020 ◽  
Author(s):  
Ana Elena Martin-Aguilar ◽  
Haidé Nayeli Núñez-López ◽  
Juan C. Ramirez-Sandoval
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Line Treatment ◽  
Second Line ◽  
Sorafenib Treatment ◽  
Sequential Inhibition ◽  
Metastatic Rcc

Abstract Background: Sequential inhibition of the vascular endothelial growth factor (VEGF) pathway with sorafenib could be useful for patients with metastatic renal cell carcinoma (RCC). Our aim was to determine the activity and tolerability of sorafenib as a second-line therapy in advanced RCC initially treated with a different VEGF-tyrosine kinase inhibitor (TKI). Methods: A prospective observational cohort in Mexico (2012–2019). We included 132 subjects with metastatic RCC and who had progression despite treatment with sunitinib. The primary end-point was time to disease progression as evaluated every 12–16 weeks. Results: The mean age of the cohort was 59 years (interquartile range [IQR] 50-72), 96 (73%) were men, and 48 (36%) had a favorable prognosis according to the IMDC (International Metastatic RCC Database Consortium) prognostic model. The median progression-free survival (PFS) and overall-survival after the introduction of sorafenib treatment was 8.6 months (95% confidence interval [CI]: 6.7–10.5) and 40 months (95% CI: 34.5–45.4) respectively. The median overall survival from RCC diagnosis to death was 71 months (95% CI: 58.2–83.8). On multivariable analyses, age >65 years was associated with a longer PFS (HR 0.51; 95% CI: 0.31-0.86; p = 0.018). The median PFS in subjects aged >65 years was longer compared to subjects ≤65 years (14.0 [95% CI: 9.2–18.8] vs . 7.2 months [95% CI: 5.3–9.1]; p = 0.012). Adverse events grade ≥3 associated with sorafenib occurred in 38 (29%) patients. Conclusion: Sequential inhibition of VEGF with sorafenib as a second-line treatment may benefit patients with metastatic RCC, especially in subjects >65 years old.

Nephrectomy Followed by Interferon Alfa-2b Compared With Interferon Alfa-2b Alone for Metastatic Renal Cell Cancer

2021 ◽  
pp. 113-118
Author(s):  
Christopher Weight
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell Cancer ◽  
Renal Cell ◽  
Performance Status ◽  
Cell Cancer ◽  
Interferon Alfa ◽  
Cytoreductive Nephrectomy

This chapter summarizes the findings of a landmark trial of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma performed in the interferon era. All enrolled patients had a good performance status. It found overall survival extended by about 3 months in the cytoreductive-nephrectomy-plus-interferon arm versus the interferon-only arm.

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