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Correa AF , Jegede OA , Haas NB , Flaherty KT , Pins MR , Adeniran A , Messing EM , Manola J , Wood CG , Kane CJ , Jewett MAS , Dutcher JP , DiPaola RS , Carducci MA , Uzzo RG
Predicting Disease Recurrence, Early Progression, and Overall Survival Following Surgical Resection for High-risk Localized and Locally Advanced Renal Cell Carcinoma
Eur Urol. 2021 Mar 8
AbstractBACKGROUND: Risk stratification for localized renal cell carcinoma (RCC) relies heavily on retrospective models, limiting their generalizability to contemporary cohorts. OBJECTIVE: To introduce a contemporary RCC prognostic model, developed using prospective, highly annotated data from a phase III adjuvant trial. DESIGN, SETTING, AND PARTICIPANTS: The model utilizes outcome data from the ECOG-ACRIN 2805 (ASSURE) RCC trial. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome for the model is disease-free survival (DFS), with overall survival (OS) and early disease progression (EDP) as secondary outcomes. Model performance was assessed using discrimination and calibration tests. RESULTS AND LIMITATIONS: A total of 1735 patients were included in the analysis, with 887 DFS events occurring over a median follow-up of 9.6 yr. Five common tumor variables (histology, size, grade, tumor necrosis, and nodal involvement) were included in each model. Tumor histology was the single most powerful predictor for each model outcome. The C-statistics at 1 yr were 78.4% and 81.9% for DFS and OS, respectively. Degradation of the DFS, DFS validation set, and OS model's discriminatory ability was seen over time, with a global c-index of 68.0% (95% confidence interval or CI [65.5, 70.4]), 68.6% [65.1%, 72.2%], and 69.4% (95% CI [66.9%, 71.9%], respectively. The EDP model had a c-index of 75.1% (95% CI [71.3, 79.0]). CONCLUSIONS: We introduce a contemporary RCC recurrence model built and internally validated using prospective and highly annotated data from a clinical trial. Performance characteristics of the current model exceed available prognostic models with the added benefit of being histology inclusive and TNM agnostic. PATIENT SUMMARY: Important decisions, including treatment protocols, clinical trial eligibility, and life planning, rest on our ability to predict cancer outcomes accurately. Here, we introduce a contemporary renal cell carcinoma prognostic model leveraging high-quality data from a clinical trial. The current model predicts three outcome measures commonly utilized in clinical practice and exceeds the predictive ability of available prognostic models.
Notes1873-7560 Correa, Andres F Jegede, Opeyemi A Haas, Naomi B Flaherty, Keith T Pins, Michael R Adeniran, Adebowale Messing, Edward M Manola, Judith Wood, Christopher G Kane, Christopher J Jewett, Michael A S Dutcher, Janice P DiPaola, Robert S Carducci, Michael A Uzzo, Robert G Journal Article Switzerland Eur Urol. 2021 Mar 8:S0302-2838(21)00145-7. doi: 10.1016/j.eururo.2021.02.025.