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Randomized Controlled Trial
. 2023 Sep;149(12):9657-9670.
doi: 10.1007/s00432-023-04885-x. Epub 2023 May 25.

Do patients with metastatic renal cell carcinoma obtain survival benefits from cytoreductive nephrectomy? A population-based study

Zhenkai Luo #  1   2 , Binbin Jiao #  3 , Qianwen Xu #  4 , Weifeng He  3 , Hang Zhao  5   6 , Yuhao Liu  5   6 , Haijie Chen  5   6 , Yunfan Guan  5   6 , Guan Zhang  7 , Zhaoqiang Jiang  8
Affiliations
Randomized Controlled Trial

Do patients with metastatic renal cell carcinoma obtain survival benefits from cytoreductive nephrectomy? A population-based study

Zhenkai Luo et al. J Cancer Res Clin Oncol. 2023 Sep.

Abstract

Purpose: This study aimed to explore the value of cytoreductive nephrectomy (CN) and develop nomograms to predict the prognosis of metastatic renal cell carcinoma (mRCC) patients with receiving radiology therapy or/and chemotherapy (RT/&CT).

Methods: Clinical data of patients with mRCC between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic nomograms were constructed to predict the overall survival (OS) and cancer-specific survival (CSS) probability for 1-, 3-, and 5- years in patients with mRCC. A series of validation methods were used to validate the accuracy and reliability of the model, including area under the receiver operating curve (AUC), consistency index (C-index), calibration curve, and decision curve analysis (DCA).

Results: 1394 patients were enrolled in this study. All patients were randomly divided into the training cohort (n = 976) and the validation cohort (n = 418). In the training cohort, multivariate Cox regression analysis suggested that pathology grade, histology type, T stage, N stage, surgery, and distant metastasis were independent risk factors for OS and CSS. The AUC and C-index were both over 0.65 in both cohorts, indicating that the nomograms for OS and CSS had satisfactory discriminative power. The calibration curves revealed that the predictive nomograms had a good consistency between the observed and the predicted survival.

Conclusion: This study provided evidence that mRCC patients underwent RT/&CT could gain survival benefits from CN. The prognostic nomogram constructed in our study is reliable and practical, may help guide clinical strategies in the treatment of mRCC.

Keywords: Cytoreductive nephrectomy; Metastatic renal cell carcinoma; Nomogram; SEER.

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Conflict of interest statement

The authors declared that this study has received no financial support and there was no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the patient screening process (A); Flowchart of the research process (B)
Fig. 2
Fig. 2
Nomogram for predicting 1-,3-, and 5-year OS (A) and CSS (B) for mRCC patients
Fig. 3
Fig. 3
Nomogram ROC curves to predict 1-,3-, and 5-year OS in the training cohort (A) and validation cohort (B); Nomogram ROC curves to predict 1-,3-, and 5-year CSS in the training cohort (C) and validation cohort (D)
Fig. 4
Fig. 4
The calibration curves of OS nomogram at 1-,3-, and 5-years in the training cohort (A) and at validation cohort (B); The calibration curves of CSS nomogram at 1-,3-, and 5-years in the training cohort (C) and at validation cohort (D)
Fig. 5
Fig. 5
DCA analysis predicting 1-,3-, and 5-year OS in the training cohort (A–C) and validation cohort (D–F)
Fig. 6
Fig. 6
DCA analysis predicting 1-,3-, and 5-year CSS in the training cohort (A–C) and validation cohort (D–F)
Fig. 7
Fig. 7
The Kaplan–Meier curves of OS nomogram in the training cohort (A) and validation cohort (B); The Kaplan–Meier curves of CSS nomogram in the training cohort (C) and validation cohort (D)
See this image and copyright information in PMC

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