目的:建立并验证预测肾切除术后临床T1/2(cT1/2)透明细胞肾细胞癌(ccRCC)患者无复发生存期(RFS)的列线图。
方法:纳入2017-2020年天津医科大学第二医院1289例cT1/2ccRCC患者的临床病理和生存资料。Cox回归分析用于确定训练和验证队列中902和387例ccRCC患者的独立危险因素。分别,并构造列线图。通过校准图评估列线图的性能,随时间变化的接收机工作特性(ROC)曲线,C指数(一致性指数),和决策曲线分析(DCA)。采用Kaplan-Meier曲线评价不同复发风险患者发生RFS的概率。
结果:年龄,肿瘤大小,手术方法,Fuhrman年级,pT3a上升阶段被确定为RFS的独立预测因子。训练队列中3年和5年RFSROC曲线的曲线下面积(AUC)分别为0.791和0.835,验证队列中的0.860和0.880。DCA和校准图证明了列线图在预测3年和5年RFS方面的最佳应用和出色的准确性。Kaplan-Meier曲线显示了训练和验证队列中三个风险组之间RFS的显着差异。临床上,开发的列线图为风险分层提供了更精确的工具,实现量身定制的术后管理和监测策略,最终旨在改善患者预后。
结论:我们开发了一个列线图,用于预测cT1/2ccRCC患者肾切除术后的RFS,具有很高的准确性。此列线图的临床实施可以显着提高临床决策,改善患者预后,优化ccRCC管理资源利用。
OBJECTIVE: To develop and validate a nomogram for predicting recurrence-free survival (RFS) for clinical T1/2 (cT1/2) clear cell renal cell carcinoma (ccRCC) patients after nephrectomy.
METHODS: Clinicopathological and survival data from 1289 cT1/2 ccRCC patients treated at the Second Hospital of Tianjin Medical University between 2017 and 2020 were included. Cox regression analysis was used to identify independent risk factors in 902 and 387 ccRCC patients in the training and
validation cohorts, respectively, and construct the nomogram. The performance of the nomogram was assessed through calibration plots, time-dependent receiver operating characteristic (ROC) curves, C-index (concordance-index), and decision curve analysis (DCA). Kaplan-Meier curves were used to evaluate the probability of RFS in patients with different recurrence risks.
RESULTS: Age, tumor size, surgical approach, Fuhrman grade, and pT3a upstage were identified as independent predictors of RFS. The area under the curve (AUC) for the 3-year and 5-year RFS ROC curves were 0.791 and 0.835 in the training cohort, and 0.860 and 0.880 in the
validation cohort. The DCA and calibration plots demonstrated the optimal application and excellent accuracy of the nomogram for predicting 3-year and 5-year RFS. Kaplan-Meier curves revealed significant differences in RFS among the three risk groups in both the training and
validation cohorts. Clinically, the developed nomogram provides a more precise tool for risk stratification, enabling tailored postoperative management and surveillance strategies, ultimately aiming to improve patient outcomes.
CONCLUSIONS: We developed a nomogram for predicting RFS in cT1/2 ccRCC patients after nephrectomy with high accuracy. The clinical implementation of this nomogram can significantly enhance clinical decision-making, leading to improved patient outcomes and optimized resource utilization in the management of ccRCC.