The first 2 authors contributed equally to this work.
Low predictive accuracy of the Kattan postoperative nomogram for renal cell carcinoma recurrence in a population of French patients
Article first published online: 30 OCT 2006
Copyright © 2006 American Cancer Society
Volume 107, Issue 11, pages 2604–2608, 1 December 2006
How to Cite
Hupertan, V., Roupret, M., Poisson, J.-F., Chretien, Y., Dufour, B., Thiounn, N. and Mejean, A. (2006), Low predictive accuracy of the Kattan postoperative nomogram for renal cell carcinoma recurrence in a population of French patients. Cancer, 107: 2604–2608. doi: 10.1002/cncr.22313
- Issue published online: 17 NOV 2006
- Article first published online: 30 OCT 2006
- Manuscript Accepted: 29 AUG 2006
- Manuscript Revised: 24 AUG 2006
- Manuscript Received: 28 JUN 2006
- renal cell;
- proportional hazards models;
- statistical model
The aim of the current study was to establish the predictive accuracy of the Kattan postoperative nomogram for nonmetastatic renal cell carcinoma (RCC) by comparing predictions with actual disease recurrence in patients who underwent surgery in a single center in France.
Between 1985 and 2000, 844 patients were treated for RCC. The following data were collated: age, symptoms, histology, tumor size, grade, TNM 1997 stage, recurrence, and progression. For each patient a prognostic score (predicted probability) for recurrence-free survival (RFS) at 5 years was calculated using the Kattan nomogram. The discriminating ability of the model was assessed by Harrell's concordance index (c-index). Bootstrapping was used to assess confidence intervals. Furthermore, survival was then estimated by the Kaplan-Meier method and Cox proportional hazards regression analysis.
In all, 565 patients (median age, 62 years) were included. At the time of the last follow-up, 81 patients had died and 101 had experienced RCC recurrence. The c-index for RFS (Kattan nomogram) was only 0.607 (95% confidence interval [CI]: 0.576–0.635). The 5-year RFS rate and cancer-specific survival rate were 81.5% and 84.7%, respectively. Of the 4 variables included in the nomogram, only TNM stage was associated with recurrence in a multivariate analysis (Cox analysis) (P = .022).
There was a discrepancy between predicted RFS as estimated by the Kattan nomogram and the likelihood of being recurrence-free at 5 years according to the Cox analysis in the current population of patients. However, until new dynamic models become available clinicians may still improve their predictive ability by using the current nomogram. Cancer 2006. © 2006 American Cancer Society.