Within the Surveillance, Epidemiology, and End Results database (2000-2019), we identified 5522 unilateral surgically treated non-metastatic chromophobe kidney cancer (chRCC) patients. This population was randomly divided into development vs. external validation cohorts. In the development cohort, the original Leibovich 2018 and GRANT categories were applied to predict 5- and 10-year cancer-specific survival (CSS). Subsequently, a novel multivariable nomogram was developed. Accuracy, calibration and decision curve analyses (DCA) tested the Cox regression-based nomogram as well as the Leibovich 2018 and GRANT risk categories in the external validation cohort. The accuracy of the Leibovich 2018 and GRANT models was 0.65 and 0.64 at ten years, respectively. The novel prognostic nomogram had an accuracy of 0.78 at ten years. All models exhibited good calibration. In DCA, Leibovich 2018 outperformed the novel nomogram within selected ranges of threshold probabilities at ten years. Conversely, the novel nomogram outperformed Leibovich 2018 for other values of threshold probabilities. In summary, Leibovich 2018 and GRANT risk categories exhibited borderline low accuracy in predicting CSS in North American non-metastatic chRCC patients. Conversely, the novel nomogram exhibited higher accuracy. However, in DCA, all examined models exhibited limitations within specific threshold probability intervals. In consequence, all three examined models provide individual predictions that might be suboptimal and be affected by limitations determined by the natural history of chRCC, where few deaths occur within ten years from surgery. Further investigations regarding established and novel predictors of CSS and relying on large sample sizes with longer follow-up are needed to better stratify CSS in chRCC.
Cancers. 2023 Apr 05*** epublish ***
Mattia Luca Piccinelli, Simone Morra, Stefano Tappero, Cristina Cano Garcia, Francesco Barletta, Reha-Baris Incesu, Lukas Scheipner, Andrea Baudo, Zhe Tian, Stefano Luzzago, Francesco Alessandro Mistretta, Matteo Ferro, Fred Saad, Shahrokh F Shariat, Luca Carmignani, Sascha Ahyai, Derya Tilki, Alberto Briganti, Felix K H Chun, Carlo Terrone, Nicola Longo, Ottavio de Cobelli, Gennaro Musi, Pierre I Karakiewicz
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 0A9, Canada., Department of Urology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria., Department of Urology, IRCCS Policlinico San Donato, 20097 Milan, Italy., Department of Urology, Medical University of Graz, 8036 Graz, Austria., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany., Division of Experimental Oncology, Unit of Urology, URI Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy., Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 39120 Frankfurt am Main, Germany., Department of Urology, IRCCS Policlinico San Martino, 16132 Genova, Italy., Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy.