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A Novel Preoperative Nomogram for Predicting Lymph Node Invasion in Renal Cell Carcinoma Patients Without Metastasis

Authors Li P, Peng C, Xie Y, Wang L, Gu L, Wu S, Shen D, Xuan Y, Ma X, Zhang X

Received 9 June 2019

Accepted for publication 8 November 2019

Published 26 November 2019 Volume 2019:11 Pages 9961—9967


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Ahmet Emre Eskazan

Pin Li,1,2,* Cheng Peng,3,* Yongpeng Xie,4,* Lei Wang,5 Liangyou Gu,1 Shengpan Wu,1 Donglai Shen,1 Yundong Xuan,1 Xin Ma,1 Xu Zhang1

1Department of Urology, State Key Laboratory of Kidney Diseases, The First Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Department of Pediatric Urology, Bayi Children’s Hospital Affiliated to the Seventh Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China; 3Department of Urology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China; 4Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 5Chinese PLA 534 Hospital, Luoyang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xu Zhang; Xin Ma
Department of Urology, Chinese PLA General Hospital, Beijing 100853, People’s Republic of China
Tel +86-10-6693-8211; +86-10-6693-8008
Fax +86-10-6822-3567;

Objective: To provide a preoperative predictive model to support clinical decision-making regarding the selection of in renal cell carcinoma (RCC) patients who will benefit the most from lymph node dissection.
Methods: This retrospective analysis enrolled 374 RCC patients without distant metastasis who underwent surgical treatment from January 2006 to December 2017. The relationships between lymph node invasion (LNI) and age at surgery; gender; body mass index(BMI); the presence of clinical symptoms such as flank pain, hematuria or a palpable mass; clinical T stage (cT stage); clinical N stage (cN stage); and the results of routine hematological and serum biochemical analyses were investigated. All the variables were included in univariate and multivariate logistic regression analyses, and the significant variables were then included in a novel nomogram to predict the probability of LNI. Then, we calibrated the nomogram with an internal validation set.
Results: Six of eighteen variables were significant in the univariate logistic regression analysis. After multivariate logistic regression analysis, age at surgery (OR=0.643, 95% CI: 0.421–0.975), cT stage (OR=3.034, 95% CI: 1.541–5.926), cN stage (OR=6.353, 95% CI: 3.273–12.456), lymphocyte percentage (OR=0.481, 95% CI: 0.256–0.894), and the presence of clinical symptoms (OR=2.045, 95% CI: 1.065–3.924) were independent predictors of LNI and were included in the nomogram. The C-index of this nomogram was 0.824.
Conclusion: Preoperative basic laboratory findings combined with the results of a physical examination and radiological examination can indicate the probability of LNI in RCC patients.

Keywords: kidney cancer, renal cell carcinoma, lymph node invasion, predictive nomogram

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