1
|
Bai J, Lu Q, Wen Y, Shangguan T, Ye Y, Lin J, Liu R, Cai W, Chen J. Development and validation of a nomogram for predicting the impact of tumor size on cancer-specific survival of locally advanced renal cell carcinoma: a SEER-based study. Aging (Albany NY) 2024; 16:3823-3836. [PMID: 38376430 PMCID: PMC10929802 DOI: 10.18632/aging.205562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/08/2024] [Indexed: 02/21/2024]
Abstract
This study was aimed to integrate tumor size with other prognostic factors into a prognostic nomogram to predict cancer-specific survival (CSS) in locally advanced (≥pT3a Nany M0) renal cell carcinoma (RCC) patients. Based on the Surveillance, Epidemiology, and End Results (SEER) database, 10,800 patients diagnosed with locally advanced RCC were collected. They were randomly divided into a training cohort (n = 7,056) and a validation cohort (n = 3,024). X-tile program was used to identify the optimal cut-off value of tumor size and age. The cut-off of age at diagnosis was 65 years old and 75 years old. The cut-off of tumor size was 54 mm and 119 mm. Univariate and multivariate Cox regression analyses were performed in the training cohort to identify independent prognostic factors for construction of nomogram. Then, the nomogram was used to predict the 1-, 3- and 5-year CSS. The performance of nomogram was evaluated by using concordance index (C-index), area under the Subject operating curve (AUC) and decision curve analysis (DCA). Moreover, the nomogram and tumor node metastasis (TNM) staging system (AJCC 8th edition) were compared. 10 variables were screened to develop the nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) indicated satisfactory ability of the nomogram. Compared with the AJCC 8th edition of TNM stage, DCA showed that the nomogram had improved performance. We developed and validated a nomogram for predicting the CSS of patients with locally advanced RCC, which was more precise than the AJCC 8th edition of TNM staging system.
Collapse
Affiliation(s)
- Junjie Bai
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Qing Lu
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yahui Wen
- The Graduate School of Fujian Medical University, Fuzhou, China
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Tong Shangguan
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Yushi Ye
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Jun Lin
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Rong Liu
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weizhong Cai
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jianhui Chen
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| |
Collapse
|
2
|
Zhanghuang C, Wang J, Yao Z, Li L, Xie Y, Tang H, Zhang K, Wu C, Yang Z, Yan B. Development and Validation of a Nomogram to Predict Cancer-Specific Survival in Elderly Patients With Papillary Renal Cell Carcinoma. Front Public Health 2022; 10:874427. [PMID: 35444972 PMCID: PMC9015096 DOI: 10.3389/fpubh.2022.874427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/14/2022] [Indexed: 12/29/2022] Open
Abstract
Objective Papillary renal cell carcinoma (pRCC) is the second most common type of renal cell carcinoma and an important disease affecting older patients. We aimed to establish a nomogram to predict cancer-specific survival (CSS) in elderly patients with pRCC. Methods Patient information was downloaded from the Surveillance, Epidemiology, and End Results (SEER) project, and we included all elderly patients with pRCC from 2004 to 2018. All patients were randomly divided into a training cohort and a validation cohort. Univariate and multivariate Cox proportional risk regression models were used to identify patient independent risk factors. We constructed a nomogram based on a multivariate Cox regression model to predict CSS for 1-, 3-, and 5- years in elderly patients with pRCC. A series of validation methods were used to validate the accuracy and reliability of the model, including consistency index (C-index), calibration curve, and area under the Subject operating curve (AUC). Results A total of 13,105 elderly patients with pRCC were enrolled. Univariate and multivariate Cox regression analysis suggested that age, tumor size, histological grade, TNM stage, surgery, radiotherapy and chemotherapy were independent risk factors for survival. We constructed a nomogram to predict patients' CSS. The training and validation cohort's C-index were 0.853 (95%CI: 0.859–0.847) and 0.855 (95%CI: 0.865–0.845), respectively, suggesting that the model had good discrimination ability. The AUC showed the same results. The calibration curve also indicates that the model has good accuracy. Conclusions In this study, we constructed a nomogram to predict the CSS of elderly pRCC patients, which has good accuracy and reliability and can help doctors and patients make clinical decisions.
Collapse
Affiliation(s)
- Chenghao Zhanghuang
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China.,Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Yunnan Key Laboratory of Children's Major Disease Research, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Jinkui Wang
- Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhigang Yao
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Li Li
- Yunnan Key Laboratory of Children's Major Disease Research, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Yucheng Xie
- Department of Pathology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Haoyu Tang
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Kun Zhang
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Chengchuang Wu
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Zhen Yang
- Department of Oncology, Yunnan Children Solid Tumor Treatment Center, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China
| | - Bing Yan
- Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China.,Yunnan Key Laboratory of Children's Major Disease Research, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Kunming, China
| |
Collapse
|
3
|
Quddus MB, Pratt N, Nabi G. Chromosomal aberrations in renal cell carcinoma: An overview with implications for clinical practice. Urol Ann 2019; 11:6-14. [PMID: 30787564 PMCID: PMC6362797 DOI: 10.4103/ua.ua_32_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chromosomal instability and aberrations are known in many cancers including renal cell carcinoma. Detailed understanding of these changes has led to an improved drug discovery and continued developments in other therapeutic options. Chromosomal aberrations have a potential to be used to monitor disease including prognostication. There has been a growing experience in cytogenetic techniques and gap between clinic and laboratory has narrowed significantly in the recent past. Nevertheless, more work on validation of these techniques, establishing threshold and interobserver agreement needs to be carried out for these diagnostic/prognostic tests before utilizing them in clinics as a part of “personalized medicine” care. The review presented here is a summary of common genetic disorders in renal cancer and some of acquired genetic changes which can be used as biomarkers. The review also describes basics of commonly used genetic techniques for wider clinical community involved in the management of renal cancer.
Collapse
Affiliation(s)
- Muhammad Bilal Quddus
- Department of Urology, Academic Urology Unit, School of Medicine, Ninewells Hospital, Dundee, Scotland, UK
| | - Norman Pratt
- Department of Urology, Clinical Genetic Unit, Ninewells Hospital, NHS Tayside, Dundee, Scotland, UK
| | - Ghulam Nabi
- Department of Urology, Academic Urology Unit, School of Medicine, Ninewells Hospital, Dundee, Scotland, UK
| |
Collapse
|
4
|
Teishima J, Ohara S, Shinmei S, Inoue S, Hayashi T, Mochizuki H, Mita K, Shigeta M, Matsubara A. Normalization of C-reactive protein levels following cytoreductive nephrectomy in patients with metastatic renal cell carcinoma treated with tyrosine kinase inhibitors is associated with improved overall survival. Urol Oncol 2018; 36:339.e9-339.e15. [DOI: 10.1016/j.urolonc.2018.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/03/2018] [Accepted: 04/16/2018] [Indexed: 10/14/2022]
|
5
|
Miyake H, Harada KI, Ozono S, Fujisawa M. Efficacy and safety of axitinib in elderly patients with metastatic renal cell carcinoma. Med Oncol 2016; 33:95. [PMID: 27444960 DOI: 10.1007/s12032-016-0813-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 07/16/2016] [Indexed: 12/31/2022]
Abstract
The objective of this study was to analyze the impact of age on clinical outcomes of metastatic renal cell carcinoma (mRCC) patients receiving axitinib. This study included 144 consecutive mRCC patients who received axitinib for at least 12 weeks as second-line therapy in a routine clinical setting. The efficacy, safety and quality of life (QOL) were compared between patients aged <75 (n = 116) and ≥75 (n = 28) years. No significant differences in the clinicopathological characteristics were noted between younger and older patients. There was no significant difference in the response rate, clinical benefit rate or proportion of patients going on to receive third-line therapy between these two groups. In addition, the progression-free and overall survivals in older patients were similar to those in younger patients. There were no significant differences in the incidences of adverse events between these two groups, except for that of fatigue, which was significantly more frequent in older than younger patients. There was no significant difference in the incidence of the discontinuation of axitinib due to adverse events between the two groups. QOL assessment at 12 weeks after the introduction of axitinib using the Medical Outcomes Study 36-Item Short Form showed no significant differences in any of the eight scale scores between the two groups. Taken together, it might be possible to achieve clinical outcomes in older patients receiving axitinib comparable to those in younger patients, suggesting that advanced age should not be a contraindication to treatment with axitinib as a second-line setting in mRCC patients.
Collapse
Affiliation(s)
- Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan. .,Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan.
| | - Ken-Ichi Harada
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Seiichiro Ozono
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
6
|
Genetic and Chromosomal Aberrations and Their Clinical Significance in Renal Neoplasms. BIOMED RESEARCH INTERNATIONAL 2015; 2015:476508. [PMID: 26448938 PMCID: PMC4584050 DOI: 10.1155/2015/476508] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/23/2015] [Accepted: 05/25/2015] [Indexed: 12/16/2022]
Abstract
The most common form of malignant renal neoplasms is renal cell carcinoma (RCC), which is classified into several different subtypes based on the histomorphological features. However, overlaps in these characteristics may present difficulties in the accurate diagnosis of these subtypes, which have different clinical outcomes. Genomic and molecular studies have revealed unique genetic aberrations in each subtype. Knowledge of these genetic changes in hereditary and sporadic renal neoplasms has given an insight into the various proteins and signalling pathways involved in tumour formation and progression. In this review, the genetic aberrations characteristic to each renal neoplasm subtype are evaluated along with the associated protein products and affected pathways. The potential applications of these genetic aberrations and proteins as diagnostic tools, prognostic markers, or therapeutic targets are also assessed.
Collapse
|
7
|
De Giorgi U, Scarpi E, Sacco C, Aieta M, Lo Re G, Sava T, Masini C, De Vincenzo F, Baldazzi V, Camerini A, Fornarini G, Burattini L, Rosti G, Ferrari V, Moscetti L, Chiuri VE, Luzi Fedeli S, Amadori D, Basso U. Standard vs Adapted Sunitinib Regimen in Elderly Patients With Metastatic Renal Cell Cancer: Results From a Large Retrospective Analysis. Clin Genitourin Cancer 2014; 12:182-9. [DOI: 10.1016/j.clgc.2013.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/27/2013] [Accepted: 11/08/2013] [Indexed: 11/28/2022]
|
8
|
Efficacy and safety of sunitinib in elderly patients with metastatic renal cell carcinoma. Br J Cancer 2014; 110:1125-32. [PMID: 24434434 PMCID: PMC3950861 DOI: 10.1038/bjc.2013.832] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 12/13/2022] Open
Abstract
Background: We retrospectively analyzed sunitinib outcome as a function of age in metastatic renal cell carcinoma (mRCC) patients. Methods: Data were pooled from 1059 patients in six trials. Kaplan–Meier estimates of progression-free survival (PFS) and overall survival (OS) were compared by log-rank test between patients aged <70 (n=857; 81%) and ⩾70 (n=202; 19%) years. Results: In first-line patients, median PFS was comparable in younger and older patients, 9.9 vs 11.0 months, respectively (HR, 0.89; 95% CI: 0.73–1.09; P=0.2629), as was median OS, 23.6 vs 25.6 months (HR, 0.93; 95% CI: 0.74–1.18; P=0.5442). Similarly, in cytokine-refractory patients, median PFS was 8.1 vs 8.4 months (HR, 0.79; 95% CI: 0.49–1.28; P=0.3350), while median OS was 20.2 vs 15.8 months (HR, 1.14; 95% CI: 0.73–1.79; P=0.5657). Some treatment-emergent adverse events were significantly less common in younger vs older patients, including fatigue (60% vs 69%), cough (20% vs 29%), peripheral edema (17% vs 27%), anemia (18% vs 25%), decreased appetite (13% vs 29%), and thrombocytopenia (16% vs 25% all P<0.05). Hand–foot syndrome was more common in younger patients (32% vs 24%). Conclusions: Advanced age should not be a deterrent to sunitinib therapy and elderly patients may achieve additional clinical benefit.
Collapse
|
9
|
Hupe MC, Merseburger AS, Lokeshwar VB, Eggers H, Rott H, Wegener G, Abbas M, Kuczyk MA, Herrmann TR. Age--an independent prognostic factor of clinical outcome in renal malignancies: results of a large study over two decades. World J Urol 2013; 32:115-21. [PMID: 24085371 DOI: 10.1007/s00345-013-1164-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/02/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Age has been linked to outcome in renal cancer patients, but mainly in North American cohorts. In this study, we hypothesized that age is correlated with metastasis and cancer-specific survival in a German cohort regardless of types of treatments. METHODS A total of 1,538 patients treated for renal malignancies between 1991 and 2010 were evaluated. Mean age and median age are 61.9 ± 11.6 and 62.6 years. Clinicopathologic [tumor type, size, grade, stage and treatment (surgery, chemotherapy, radiation, immunotherapy)] and outcome parameters (metastasis and survival) were examined for an association with age using logistic regression and Cox proportional hazard model, and Kaplan-Meier plots. RESULTS Age was associated with stage, metastasis, treatment, cancer-specific and overall mortality (p < 0.01). The metastasis-free and cancer-free survival rates for patients >63 years were lower than those for patients ≤63 years (p < 0.0001). In a multivariate analysis, age was an independent prognostic factor of metastasis, cancer-specific and overall mortality (p < 0.0001) even when data were stratified in different decades and treatment was included as one of the parameters. Patients >63 years of age had 29-35% higher risk of metastasis and cancer-specific mortality than younger patients. Median metastasis-free and cancer-specific survival for patients >63 years of age (months: 84.4; 70.3) was ~50% shorter than in patients ≤63 years (months: 151; 144.6). CONCLUSIONS This large study shows that, despite advances in surgical and non-surgical treatment modalities over the two decades, age is an independent prognostic indicator of metastasis and cancer-specific mortality in renal cancer patients. Patients >63 years have ~30% increased risk for metastasis and ~50% shorter cancer-specific survival.
Collapse
Affiliation(s)
- Marie C Hupe
- Department of Urology and Urologic Oncology, Hannover Medical School (OE 6240), Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
| | | | | | | | | | | | | | | | | |
Collapse
|