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Development and Validation of a Nomogram Predicting the Prognosis of Renal Cell Carcinoma After Nephrectomy

Authors Xia M, Yang H, Wang Y, Yin K, Bian X, Chen J, Shuang W

Received 18 February 2020

Accepted for publication 26 May 2020

Published 11 June 2020 Volume 2020:12 Pages 4461—4473

DOI https://doi.org/10.2147/CMAR.S250371

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Eileen O'Reilly


Mancheng Xia,1 Haosen Yang,2 Yusheng Wang,1 Keqiang Yin,1 Xiaodong Bian,1 Jiawei Chen,1 Weibing Shuang3

1First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China; 2Kidney Transplantation Center, Shanxi Second People’s Hospital, Taiyuan, People’s Republic of China; 3Department of Urology, The First Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China

Correspondence: Weibing Shuang
Department of Urology, The First Hospital of Shanxi Medical University, No. 85, JieFang South Road, Yingze District, Taiyuan 030001, People’s Republic of China
Email shuangweibing@126.com

Objective: To develop and validate a nomogram for predicting the overall survival (OS) of renal cell carcinoma (RCC) patients after nephrectomy.
Materials and Methods: In total, 488 patients with RCC who underwent nephrectomy at the Urology Department of the First Hospital of Shanxi Medical University between January 2013 and December 2018 were randomly divided into a development cohort (n = 344) and a validation cohort (n = 144). The development cohort was used to build a prediction model, and the validation cohort was used for validation. Single-factor and multifactor analyses were carried out with R software, and the nomogram, calibration chart, ROC curve and C index were constructed.
Results: The median follow-up time of the development and validation cohorts was 34 months. The total 3-year and 5-year survival rates of the development cohort were 93.3% and 91.6%, respectively; those of the validation cohort were 92.4% and 91.0%, respectively. Cox univariate analysis of the development cohort showed that age, type 2 diabetes mellitus (T2DM), smoking history, type of surgery, T stage, N stage, M stage and Fuhrman nuclear grade were prognostic factors for OS in RCC patients undergoing nephrectomy. Cox multivariate analysis showed that T2DM, smoking history and T stage were independent prognostic factors for OS in RCC patients undergoing nephrectomy (P < 0.05). According to the univariate and multivariate analyses, a nomogram was constructed. In the development cohort, the C index of predicted OS was 0.875 (95% CI, 0.820– 0.930). The calibration curve of the 3-year and 5-year survival rates showed that the predicted value of the nomogram was consistent with the actual observed value. The area under the 3-year and 5-year survival ROC curves was 0.861 and 0.901, respectively. In the validation cohort, the C index was 0.880 (95% CI, 0.778– 0.982). The calibration curve of the 3-year and 5-year survival rates showed that the predicted value of the nomogram was consistent with the actual observed value. The area under the 3-year and 5-year survival ROC curves was 0.813 and 0.799, respectively.
Conclusion: We developed and verified a new and accurate nomogram with available clinicopathological data that can effectively predict the OS of RCC patients after nephrectomy.

Keywords: renal cell carcinoma, prognosis, nomogram, influencing factors

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