The difficulty in selecting patients for cytoreductive nephrectomy: An evaluation of previously described predictive models

Abstract Purpose To externally evaluate a preoperative points system and a preoperative nomogram, both created to assess time to death after cytoreductive nephrectomy (CN). Materials and methods We identified 298 patients who underwent CN at our institution, a tertiary cancer center, between 1989 and 2015. To validate the points system, we compared reported overall survival (OS) for each criterion to observed OS in our cohort. To evaluate the nomogram, we prognosticated risk of death at 6 months after surgery for 280 patients with sufficient follow-up in our cohort and evaluated discrimination using area under the curve (AUC) and calibration. Decision curve analysis was performed to assess clinical utility of the nomogram. Results Significant differences in OS were observed between patients with and without 5 of 7 criteria on univariate analysis: low albumin ( P