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 an...
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| creator | Manley, Brandon J., M.D Tennenbaum, Daniel M., B.S Vertosick, Emily A., M.P.H Hsieh, James J., M.D., PhD Sjoberg, Daniel D., M.A Assel, Melissa, M.A Benfante, Nicole E., B.S Strope, Seth A., M.D., M.P.H Kim, Eric, M.D Casuscelli, Jozefina, M.D Becerra, Maria F., M.D Coleman, Jonathan A., M.D Hakimi, Abraham Ari, M.D Russo, Paul, M.D |
| description | 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 |
| doi_str_mv | 10.1016/j.urolonc.2016.07.010 |
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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 <0.0001), high lactate dehydrogenase ( P = 0.002), liver metastasis ( P = 0.004), retroperitoneal lymphadenopathy ( P = 0.002), and supradiaphragmatic lymphadenopathy ( P = 0.019). Discrimination from the preoperative model, predicting death within 6 months of surgery was lower in our cohort (AUC = 0.65, 95% CI: 0.52–0.79) than the original publication (AUC = 0.76). Decision curve analysis demonstrated little benefit for applicability. Conclusions Five previously defined risk factors are predictive of decreased OS after CN in our cohort. We found lower discrimination using the preoperative model and minimal clinical utility according to decision analysis in our study cohort. These findings suggest the need for improved models to aid patient stratification and consequent treatment choice.</description><identifier>ISSN: 1078-1439</identifier><identifier>EISSN: 1873-2496</identifier><identifier>DOI: 10.1016/j.urolonc.2016.07.010</identifier><identifier>PMID: 27567689</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Carcinoma, Renal Cell - mortality ; Carcinoma, Renal Cell - secondary ; Carcinoma, Renal Cell - surgery ; Cytoreduction Surgical Procedures - mortality ; Decision Support Techniques ; Diaphragm ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms - mortality ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; L-Lactate Dehydrogenase - blood ; Liver Neoplasms - mortality ; Liver Neoplasms - secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Mortality ; Neoplasm metastasis ; Nephrectomy ; Nephrectomy - methods ; Nephrectomy - mortality ; Nomograms ; Patient Selection ; Preoperative Period ; Prognosis ; Proportional Hazards Models ; Renal cell carcinoma ; Retroperitoneal Space ; Risk Assessment - methods ; Serum Albumin - metabolism ; Survival Rate ; Time Factors ; Urology</subject><ispartof>Urologic oncology, 2017-01, Vol.35 (1), p.35.e1-35.e5</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c658t-236d7d2a01780f773410aede28c44b9d7901da4130eee23d79358ad3c21375873</citedby><cites>FETCH-LOGICAL-c658t-236d7d2a01780f773410aede28c44b9d7901da4130eee23d79358ad3c21375873</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.urolonc.2016.07.010$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27567689$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Manley, Brandon J., M.D</creatorcontrib><creatorcontrib>Tennenbaum, Daniel M., B.S</creatorcontrib><creatorcontrib>Vertosick, Emily A., M.P.H</creatorcontrib><creatorcontrib>Hsieh, James J., M.D., PhD</creatorcontrib><creatorcontrib>Sjoberg, Daniel D., M.A</creatorcontrib><creatorcontrib>Assel, Melissa, M.A</creatorcontrib><creatorcontrib>Benfante, Nicole E., B.S</creatorcontrib><creatorcontrib>Strope, Seth A., M.D., M.P.H</creatorcontrib><creatorcontrib>Kim, Eric, M.D</creatorcontrib><creatorcontrib>Casuscelli, Jozefina, M.D</creatorcontrib><creatorcontrib>Becerra, Maria F., M.D</creatorcontrib><creatorcontrib>Coleman, Jonathan A., M.D</creatorcontrib><creatorcontrib>Hakimi, Abraham Ari, M.D</creatorcontrib><creatorcontrib>Russo, Paul, M.D</creatorcontrib><title>The difficulty in selecting patients for cytoreductive nephrectomy: An evaluation of previously described predictive models</title><title>Urologic oncology</title><addtitle>Urol Oncol</addtitle><description>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 <0.0001), high lactate dehydrogenase ( P = 0.002), liver metastasis ( P = 0.004), retroperitoneal lymphadenopathy ( P = 0.002), and supradiaphragmatic lymphadenopathy ( P = 0.019). Discrimination from the preoperative model, predicting death within 6 months of surgery was lower in our cohort (AUC = 0.65, 95% CI: 0.52–0.79) than the original publication (AUC = 0.76). Decision curve analysis demonstrated little benefit for applicability. Conclusions Five previously defined risk factors are predictive of decreased OS after CN in our cohort. We found lower discrimination using the preoperative model and minimal clinical utility according to decision analysis in our study cohort. These findings suggest the need for improved models to aid patient stratification and consequent treatment choice.</description><subject>Aged</subject><subject>Carcinoma, Renal Cell - mortality</subject><subject>Carcinoma, Renal Cell - secondary</subject><subject>Carcinoma, Renal Cell - surgery</subject><subject>Cytoreduction Surgical Procedures - mortality</subject><subject>Decision Support Techniques</subject><subject>Diaphragm</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Kidney Neoplasms - mortality</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidney Neoplasms - surgery</subject><subject>L-Lactate Dehydrogenase - blood</subject><subject>Liver Neoplasms - mortality</subject><subject>Liver Neoplasms - secondary</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neoplasm metastasis</subject><subject>Nephrectomy</subject><subject>Nephrectomy - methods</subject><subject>Nephrectomy - mortality</subject><subject>Nomograms</subject><subject>Patient Selection</subject><subject>Preoperative Period</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Renal cell carcinoma</subject><subject>Retroperitoneal Space</subject><subject>Risk Assessment - methods</subject><subject>Serum Albumin - metabolism</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Urology</subject><issn>1078-1439</issn><issn>1873-2496</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUk1v1DAQjRCIlsJPAPnIJakdJ7HDoaiqgCJV4kA5W1570vXi2IudrBTx55lolwq4cPLHvHkz894UxWtGK0ZZd7mr5hR9DKaq8VlRUVFGnxTnTApe1k3fPcU7FbJkDe_Pihc57yhljWTseXFWi7YTnezPi5_3WyDWDYMzs58W4gLJ4MFMLjyQvZ4chCmTISZilikmsDOGDkAC7LcJYXFc3pHrQOCg_YzwGEgcyD7BwcU5-4VYyCa5Ddj107pj9hgt-PyyeDZon-HV6bwovn38cH9zW959-fT55vquNF0rp7LmnRW21pQJSQcheMOoBgu1NE2z6a3oKbO6YZwCQM3xzVupLTc146JFOS6KqyPvft6MYA2OlLRX--RGnRYVtVN_R4Lbqod4UC1rG9kyJHh7Ikjxxwx5UqPLBrzXAXBKxSRvu67BbhHaHqEmxZwTDI9lGFWrcWqnTsap1ThFhULjMO_Nnz0-Zv12CgHvjwAUDsWFpLJBcwxquvqgbHT_LXH1D4PxLjij_XdYIO_inALaoJjKtaLq67o96_KwjqP0vOe_AJLkxZk</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Manley, Brandon J., M.D</creator><creator>Tennenbaum, Daniel M., B.S</creator><creator>Vertosick, Emily A., M.P.H</creator><creator>Hsieh, James J., M.D., PhD</creator><creator>Sjoberg, Daniel D., M.A</creator><creator>Assel, Melissa, M.A</creator><creator>Benfante, Nicole E., B.S</creator><creator>Strope, Seth A., M.D., M.P.H</creator><creator>Kim, Eric, M.D</creator><creator>Casuscelli, Jozefina, M.D</creator><creator>Becerra, Maria F., M.D</creator><creator>Coleman, Jonathan A., M.D</creator><creator>Hakimi, Abraham Ari, M.D</creator><creator>Russo, Paul, M.D</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170101</creationdate><title>The difficulty in selecting patients for cytoreductive nephrectomy: An evaluation of previously described predictive models</title><author>Manley, Brandon J., M.D ; Tennenbaum, Daniel M., B.S ; Vertosick, Emily A., M.P.H ; Hsieh, James J., M.D., PhD ; Sjoberg, Daniel D., M.A ; Assel, Melissa, M.A ; Benfante, Nicole E., B.S ; Strope, Seth A., M.D., M.P.H ; Kim, Eric, M.D ; Casuscelli, Jozefina, M.D ; Becerra, Maria F., M.D ; Coleman, Jonathan A., M.D ; Hakimi, Abraham Ari, M.D ; Russo, Paul, M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c658t-236d7d2a01780f773410aede28c44b9d7901da4130eee23d79358ad3c21375873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Carcinoma, Renal Cell - mortality</topic><topic>Carcinoma, Renal Cell - secondary</topic><topic>Carcinoma, Renal Cell - surgery</topic><topic>Cytoreduction Surgical Procedures - mortality</topic><topic>Decision Support Techniques</topic><topic>Diaphragm</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Kidney Neoplasms - mortality</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>L-Lactate Dehydrogenase - blood</topic><topic>Liver Neoplasms - mortality</topic><topic>Liver Neoplasms - secondary</topic><topic>Lymphatic Metastasis</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neoplasm metastasis</topic><topic>Nephrectomy</topic><topic>Nephrectomy - methods</topic><topic>Nephrectomy - mortality</topic><topic>Nomograms</topic><topic>Patient Selection</topic><topic>Preoperative Period</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Renal cell carcinoma</topic><topic>Retroperitoneal Space</topic><topic>Risk Assessment - methods</topic><topic>Serum Albumin - metabolism</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Manley, Brandon J., M.D</creatorcontrib><creatorcontrib>Tennenbaum, Daniel M., B.S</creatorcontrib><creatorcontrib>Vertosick, Emily A., M.P.H</creatorcontrib><creatorcontrib>Hsieh, James J., M.D., PhD</creatorcontrib><creatorcontrib>Sjoberg, Daniel D., M.A</creatorcontrib><creatorcontrib>Assel, Melissa, M.A</creatorcontrib><creatorcontrib>Benfante, Nicole E., B.S</creatorcontrib><creatorcontrib>Strope, Seth A., M.D., M.P.H</creatorcontrib><creatorcontrib>Kim, Eric, M.D</creatorcontrib><creatorcontrib>Casuscelli, Jozefina, M.D</creatorcontrib><creatorcontrib>Becerra, Maria F., M.D</creatorcontrib><creatorcontrib>Coleman, Jonathan A., M.D</creatorcontrib><creatorcontrib>Hakimi, Abraham Ari, M.D</creatorcontrib><creatorcontrib>Russo, Paul, M.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Urologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Manley, Brandon J., M.D</au><au>Tennenbaum, Daniel M., B.S</au><au>Vertosick, Emily A., M.P.H</au><au>Hsieh, James J., M.D., PhD</au><au>Sjoberg, Daniel D., M.A</au><au>Assel, Melissa, M.A</au><au>Benfante, Nicole E., B.S</au><au>Strope, Seth A., M.D., M.P.H</au><au>Kim, Eric, M.D</au><au>Casuscelli, Jozefina, M.D</au><au>Becerra, Maria F., M.D</au><au>Coleman, Jonathan A., M.D</au><au>Hakimi, Abraham Ari, M.D</au><au>Russo, Paul, M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The difficulty in selecting patients for cytoreductive nephrectomy: An evaluation of previously described predictive models</atitle><jtitle>Urologic oncology</jtitle><addtitle>Urol Oncol</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>35</volume><issue>1</issue><spage>35.e1</spage><epage>35.e5</epage><pages>35.e1-35.e5</pages><issn>1078-1439</issn><eissn>1873-2496</eissn><abstract>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 <0.0001), high lactate dehydrogenase ( P = 0.002), liver metastasis ( P = 0.004), retroperitoneal lymphadenopathy ( P = 0.002), and supradiaphragmatic lymphadenopathy ( P = 0.019). Discrimination from the preoperative model, predicting death within 6 months of surgery was lower in our cohort (AUC = 0.65, 95% CI: 0.52–0.79) than the original publication (AUC = 0.76). Decision curve analysis demonstrated little benefit for applicability. Conclusions Five previously defined risk factors are predictive of decreased OS after CN in our cohort. We found lower discrimination using the preoperative model and minimal clinical utility according to decision analysis in our study cohort. These findings suggest the need for improved models to aid patient stratification and consequent treatment choice.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27567689</pmid><doi>10.1016/j.urolonc.2016.07.010</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Carcinoma, Renal Cell - mortality Carcinoma, Renal Cell - secondary Carcinoma, Renal Cell - surgery Cytoreduction Surgical Procedures - mortality Decision Support Techniques Diaphragm Female Follow-Up Studies Humans Kidney Neoplasms - mortality Kidney Neoplasms - pathology Kidney Neoplasms - surgery L-Lactate Dehydrogenase - blood Liver Neoplasms - mortality Liver Neoplasms - secondary Lymphatic Metastasis Male Middle Aged Mortality Neoplasm metastasis Nephrectomy Nephrectomy - methods Nephrectomy - mortality Nomograms Patient Selection Preoperative Period Prognosis Proportional Hazards Models Renal cell carcinoma Retroperitoneal Space Risk Assessment - methods Serum Albumin - metabolism Survival Rate Time Factors Urology |
| title | The difficulty in selecting patients for cytoreductive nephrectomy: An evaluation of previously described predictive models |
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