The first 3 authors contributed equally to this work.
The Karakiewicz nomogram is the most useful clinical predictor for survival outcomes in patients with localized renal cell carcinoma
Article first published online: 12 MAY 2011
Copyright © 2011 American Cancer Society
Volume 117, Issue 23, pages 5314–5324, 1 December 2011
How to Cite
Tan, M.-H., Li, H., Choong, C. V., Chia, K. S., Toh, C. K., Tang, T., Tan, P. H., Wong, C. F., Lau, W. and Cheng, C. (2011), The Karakiewicz nomogram is the most useful clinical predictor for survival outcomes in patients with localized renal cell carcinoma. Cancer, 117: 5314–5324. doi: 10.1002/cncr.26193
- Issue published online: 18 NOV 2011
- Article first published online: 12 MAY 2011
- Manuscript Accepted: 24 MAR 2011
- Manuscript Revised: 21 MAR 2011
- Manuscript Received: 24 SEP 2010
- National Kidney Foundation Singapore. Grant Number: NKFRC08111-4
- National Cancer Center Singapore. Grant Number: NRFGC09101
- Singapore Millenium Foundation
- renal cell carcinoma;
- adjuvant chemotherapy;
- likelihood functions;
- decision curve analysis
Outcomes after surgical removal of localized renal cell carcinoma (RCC) are variable. There have been multiple prognostic nomograms and risk groups developed for estimation of survival outcomes, with different models in use for evaluating patient eligibility in ongoing trials of adjuvant therapy. The authors aimed to establish the most useful prognostic model for patients with localized RCC to guide trial design, biomarker research, and clinical counseling.
A total of 390 consecutive patients who underwent nephrectomy for sporadic localized RCC in a tertiary institution (1990-2006) with 65 months median follow-up were retrospectively evaluated. The Karakiewicz nomogram, the Kattan nomogram, the Sorbellini nomogram, and the Leibovich model were compared in predicting survival outcomes (overall survival, cancer-specific survival, and freedom from recurrence) using likelihood analysis, adequacy indices, decision curve analysis, calibration, and concordance indices.
Overall, the Karakiewicz nomogram outperformed the Kattan nomogram, the Sorbellini nomogram, and the Leibovich model. Highly improved accuracy was seen using the Karakiewicz nomogram in survival prediction, using likelihood ratio analysis in bivariate models including the competing prognostic models. The Karakiewicz nomogram showed higher adequacy and concordance indices and improved clinical benefit relative to all other nomograms. All 4 models were reasonably calibrated. Exploratory comparisons of prespecified discretized Karakiewicz nomograms and the SORCE trial recruitment criteria (a discretized Leibovich model) of high-risk patients favored the discretized Karakiewicz nomograms.
The Karakiewicz nomogram was shown to be superior to the other tested nomograms and risk groups in predicting survival outcomes in localized RCC. Routine integration of this model into trial design and biomarker research should be considered. Cancer 2011;. © 2011 American Cancer Society.