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. 2024 Feb 19;16(4):3823-3836.
doi: 10.18632/aging.205562. Epub 2024 Feb 19.

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

Junjie Bai  1   2 , Qing Lu  1 , Yahui Wen  2   3   4 , Tong Shangguan  1   2 , Yushi Ye  1   2 , Jun Lin  1   2 , Rong Liu  1 , Weizhong Cai  1 , Jianhui Chen  1
Affiliations

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

Junjie Bai et al. Aging (Albany NY). .

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.

Keywords: locally advanced renal cell carcinoma; nomogram; prognosis; surveillance, epidemiology, and end results (SEER); survival analysis.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare no conflicts of interest related to this study.

Figures

Figure 1
Figure 1
X-tile analysis of cancer-specific survival according to age at diagnosis. (A) X-tile plot of the age. (B) Cutoffs were depicted with histogram of the entire cohort. (C) Prognoses based on cutoffs are illustrated using Kaplan–Meier plots.
Figure 2
Figure 2
X-tile analysis of cancer-specific survival according to tumor size. (A) X-tile plot of tumor size. (B) Cutoffs were depicted with histogram of the entire cohort. (C) Prognoses based on cutoffs were illustrated using Kaplan–Meier plots.
Figure 3
Figure 3
The cancer-specific survival rates in the training cohort and the validation cohort.
Figure 4
Figure 4
A nomogram predicting 1-, 3- and 5-year CSS of patients with locally advanced RCC. (A) Calibration plots of the relationship between predicted probabilities and actual values based on nomograms. (B–D) calibration curves for 1-year, 3-year and 5-year CSS in the training cohort; (E–G) calibration curves for 1-year, 3-year and 5-year CSS in the validation cohort).
Figure 5
Figure 5
AUC for predicting 1-, 3-, and 5-year CSS in the training cohort and the validation cohort (A–C).
Figure 6
Figure 6
Decision curve analysis of the 1-, 3-, and 5-year CSS nomogram compared with that of AJCC 8th edition TNM stage in the validation cohort (A–C).
Figure 7
Figure 7
Flowchart displaying the extraction process of locally advanced RCC (≥pT3a Nany M0) cases in SEER database.
See this image and copyright information in PMC

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