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Joo YS, Kim HW, Baek CH, Park JT, Lee H, Lim BJ, Yoo TH, Moon KC, Chin HJ, Kang SW, Han SH. External validation of the International Prediction Tool in Korean patients with immunoglobulin A nephropathy. Kidney Res Clin Pract 2022; 41:556-566. [PMID: 35545218 PMCID: PMC9576458 DOI: 10.23876/j.krcp.22.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/02/2022] [Indexed: 11/11/2022] Open
Abstract
Background The International IgA Nephropathy Prediction Tool (International IgA Nephropathy Prediction Tool) has been recently developed to estimate the progression risk of immunoglobulin A nephropathy (IgAN). This study aimed to evaluate the clinical performance of this prediction tool in a large IgAN cohort in Korea. Methods The study cohort was comprised of 2,064 patients with biopsy-proven IgAN from four medical centers between March 2012 and September 2021. We calculated the predicted risk for each patient. The primary outcome was occurrence of a 50% decline in estimated glomerular filtration rate (eGFR) from the time of biopsy or end-stage kidney disease. The model performance was evaluated for discrimination, calibration, and reclassification. We also constructed and tested an additional model with a new coefficient for the Korean race. Results During a median follow-up period of 3.8 years (interquartile range, 1.8–6.6 years), 363 patients developed the primary outcome. The two prediction models exhibited good discrimination power, with a C-statistic of 0.81. The two models generally underestimated the risk of the primary outcome, with lesser underestimation for the model with race. The model with race showed better performance in reclassification compared to the model without race (net reclassification index, 0.13). The updated model with the Korean coefficient showed good agreement between predicted risk and observed outcome. Conclusion In Korean IgAN patients, International IgA Nephropathy Prediction Tool had good discrimination power but underestimated the risk of progression. The updated model with the Korean coefficient showed acceptable calibration and warrants external validation.
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Affiliation(s)
- Young Su Joo
- Department of Internal Medicine and Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Division of Nephrology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Hyung Woo Kim
- Department of Internal Medicine and Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chung Hee Baek
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine and Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Beom Jin Lim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine and Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine and Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine and Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Correspondence: Seung Hyeok Han Department of Internal Medicine and Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. E-mail:
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Diaz-Ramirez LG, Lee SJ, Smith AK, Gan S, Boscardin WJ. A Novel Method for Identifying a Parsimonious and Accurate Predictive Model for Multiple Clinical Outcomes. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 204:106073. [PMID: 33831724 PMCID: PMC8098121 DOI: 10.1016/j.cmpb.2021.106073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 03/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Most methods for developing clinical prognostic models focus on identifying parsimonious and accurate models to predict a single outcome; however, patients and providers often want to predict multiple outcomes simultaneously. As an example, for older adults one is often interested in predicting nursing home admission as well as mortality. We propose and evaluate a novel predictor-selection computing method for multiple outcomes and provide the code for its implementation. METHODS Our proposed algorithm selected the best subset of common predictors based on the minimum average normalized Bayesian Information Criterion (BIC) across outcomes: the Best Average BIC (baBIC) method. We compared the predictive accuracy (Harrell's C-statistic) and parsimony (number of predictors) of the model obtained using the baBIC method with: 1) a subset of common predictors obtained from the union of optimal models for each outcome (Union method), 2) a subset obtained from the intersection of optimal models for each outcome (Intersection method), and 3) a model with no variable selection (Full method). We used a case-study data from the Health and Retirement Study (HRS) to demonstrate our method and conducted a simulation study to investigate performance. RESULTS In the case-study data and simulations, the average Harrell's C-statistics across outcomes of the models obtained with the baBIC and Union methods were comparable. Despite the similar discrimination, the baBIC method produced more parsimonious models than the Union method. In contrast, the models selected with the Intersection method were the most parsimonious, but with worst predictive accuracy, and the opposite was true in the Full method. In the simulations, the baBIC method performed well by identifying many of the predictors selected in the baBIC model of the case-study data most of the time and excluding those not selected in the majority of the simulations. CONCLUSIONS Our method identified a common subset of variables to predict multiple clinical outcomes with superior balance between parsimony and predictive accuracy to current methods.
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Affiliation(s)
- L Grisell Diaz-Ramirez
- Division of Geriatrics, University of California, San Francisco, 490 Illinois Street, Floor 08, Box 1265, San Francisco, CA 94143, United States; San Francisco Veterans Affairs (VA) Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94121, United States.
| | - Sei J Lee
- Division of Geriatrics, University of California, San Francisco, 490 Illinois Street, Floor 08, Box 1265, San Francisco, CA 94143, United States; San Francisco Veterans Affairs (VA) Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94121, United States.
| | - Alexander K Smith
- Division of Geriatrics, University of California, San Francisco, 490 Illinois Street, Floor 08, Box 1265, San Francisco, CA 94143, United States; San Francisco Veterans Affairs (VA) Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94121, United States.
| | - Siqi Gan
- Division of Geriatrics, University of California, San Francisco, 490 Illinois Street, Floor 08, Box 1265, San Francisco, CA 94143, United States; San Francisco Veterans Affairs (VA) Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94121, United States.
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco, 490 Illinois Street, Floor 08, Box 1265, San Francisco, CA 94143, United States; San Francisco Veterans Affairs (VA) Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94121, United States.
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You T, Song K, Guo W, Fu Y, Wang K, Zheng H, Yang J, Jin L, Qi L, Guo Z, Zhao W. A Qualitative Transcriptional Signature for Predicting CpG Island Methylator Phenotype Status of the Right-Sided Colon Cancer. Front Genet 2020; 11:971. [PMID: 33193579 PMCID: PMC7658404 DOI: 10.3389/fgene.2020.00971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/31/2020] [Indexed: 12/24/2022] Open
Abstract
A part of colorectal cancer which is characterized by simultaneous numerous hypermethylation CpG islands sites is defined as CpG island methylator phenotype (CIMP) status. Stage II and III CIMP−positive (CIMP+) right-sided colon cancer (RCC) patients have a better prognosis than CIMP−negative (CIMP−) RCC treated with surgery alone. However, there is no gold standard available in defining CIMP status. In this work, we selected the gene pairs whose relative expression orderings (REOs) were associated with the CIMP status, to develop a qualitative transcriptional signature to individually predict CIMP status for stage II and III RCC. Based on the REOs of gene pairs, a signature composed of 19 gene pairs was developed to predict the CIMP status of RCC through a feature selection process. A sample is predicted as CIMP+ when the gene expression orderings of at least 12 gene pairs vote for CIMP+; otherwise the CIMP−. The difference of prognosis between the predicted CIMP+ and CIMP− groups was more significantly different than the original CIMP status groups. There were more differential methylation and expression characteristics between the two predicted groups. The hierarchical clustering analysis showed that the signature could perform better for predicting CIMP status of RCC than current methods. In conclusion, the qualitative transcriptional signature for classifying CIMP status at the individualized level can predict outcome and guide therapy for RCC patients.
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Affiliation(s)
- Tianyi You
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Kai Song
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Wenbing Guo
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Yelin Fu
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Kai Wang
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Hailong Zheng
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Jing Yang
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Liangliang Jin
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Lishuang Qi
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Zheng Guo
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China.,Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China.,Fujian Provincial Key Laboratory on Hematology, Fujian Medical University, Fuzhou, China
| | - Wenyuan Zhao
- Department of Systems Biology, College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
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Wei X, Choudhury Y, Lim WK, Anema J, Kahnoski RJ, Lane B, Ludlow J, Takahashi M, Kanayama HO, Belldegrun A, Kim HL, Rogers C, Nicol D, Teh BT, Tan MH. Recognizing the Continuous Nature of Expression Heterogeneity and Clinical Outcomes in Clear Cell Renal Cell Carcinoma. Sci Rep 2017; 7:7342. [PMID: 28779136 PMCID: PMC5544702 DOI: 10.1038/s41598-017-07191-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 06/23/2017] [Indexed: 01/06/2023] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) has been previously classified into putative discrete prognostic subtypes by gene expression profiling. To investigate the robustness of these proposed subtype classifications, we evaluated 12 public datasets, together with a new dataset of 265 ccRCC gene expression profiles. Consensus clustering showed unstable subtype and principal component analysis (PCA) showed a continuous spectrum both within and between datasets. Considering the lack of discrete delineation and continuous spectrum observed, we developed a continuous quantitative prognosis score (Continuous Linear Enhanced Assessment of RCC, or CLEAR score). Prognostic performance was evaluated in independent cohorts from The Cancer Genome Atlas (TCGA) (n = 414) and EMBL-EBI (n = 53), CLEAR score demonstrated both superior prognostic estimates and inverse correlation with anti-angiogenic tyrosine-kinase inhibition in comparison to previously proposed discrete subtyping classifications. Inverse correlation with high-dose interleukin-2 outcomes was also observed for the CLEAR score. Multiple somatic mutations (VHL, PBRM1, SETD2, KDM5C, TP53, BAP1, PTEN, MTOR) were associated with the CLEAR score. Application of the CLEAR score to independent expression profiling of intratumoral ccRCC regions demonstrated that average intertumoral heterogeneity exceeded intratumoral expression heterogeneity. Wider investigation of cancer biology using continuous approaches may yield insights into tumor heterogeneity; single cell analysis may provide a key foundation for this approach.
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Affiliation(s)
- Xiaona Wei
- Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos, 138669, Singapore, Republic of Singapore
- MRL IT, MSD International GmbH (Singapore Branch), 1 Fusionopolis Place, #06-10/07-18, Galaxis, Singapore, 138522, Republic of Singapore
| | - Yukti Choudhury
- Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos, 138669, Singapore, Republic of Singapore
- Lucence Diagnostics Pte Ltd, Singapore, Republic of Singapore
| | - Weng Khong Lim
- Cancer Stem Cell Biology Program, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Republic of Singapore
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, #12-01, Singapore, 117599, Republic of Singapore
| | - John Anema
- Urologic Consultants, 25 Michigan Street, Suite 3300, Grand Rapids, MI, 49503, USA
| | - Richard J Kahnoski
- Division of Urology, Spectrum Health Medical Group, 4069 Lake Drive SE, Suite 313, Grand Rapids, MI, 49546, USA
| | - Brian Lane
- Division of Urology, Spectrum Health Medical Group, 4069 Lake Drive SE, Suite 313, Grand Rapids, MI, 49546, USA
| | - John Ludlow
- Western Michigan Urological Associates, 577 Michigan Avenue, Suite 201, Holland, MI, 49423, USA
| | - Masayuki Takahashi
- Department of Urology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hiro-Omi Kanayama
- Department of Urology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Arie Belldegrun
- FACS, Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California Los Angeles, 66-118 Center for Health Sciences Box 951738, Los Angeles, CA, 90095, USA
| | - Hyung L Kim
- Division of Urology, Cedars-Sinai Medical Center, 8635W. Third Street, Suite 1070, Los Angeles, CA, 90048, USA
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Hospital, 2799W. Grand Blvd, Detroit, MI, USA
| | - David Nicol
- Department of Urology, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Bin Tean Teh
- Cancer Stem Cell Biology Program, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Republic of Singapore.
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Republic of Singapore.
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, #12-01, Singapore, 117599, Republic of Singapore.
| | - Min-Han Tan
- Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos, 138669, Singapore, Republic of Singapore.
- Lucence Diagnostics Pte Ltd, Singapore, Republic of Singapore.
- Cancer Science Institute of Singapore, National University of Singapore, 14 Medical Drive, #12-01, Singapore, 117599, Republic of Singapore.
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Republic of Singapore.
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