Life expectancy models are useful tools to support clinical decision-making. Prior models have not been used widely in clinical practice for patients with renal masses. We sought to develop and validate a model to predict life expectancy following the detection of a localized renal mass suspicious for renal cell carcinoma.
Using retrospective data from 2 large centers, we identified patients diagnosed with clinically localized renal parenchymal masses from 1998 to 2018. After 2:1 random sampling into a derivation and validation cohort stratified by site, we used age, sex, log-transformed tumor size, simplified cardiovascular index and planned treatment to fit a Cox regression model to predict all-cause mortality from the time of diagnosis. The model's discrimination was evaluated using a C-statistic, and calibration was evaluated visually at 1, 5, and 10 years.
We identified 2,667 patients (1,386 at Corewell Health and 1,281 at Johns Hopkins) with renal masses. Of these, 420 (16%) died with a median follow-up of 5.2 years (interquartile range 2.2-8.3). Statistically significant predictors in the multivariable Cox regression model were age (hazard ratio [HR] 1.04; 95% confidence interval [CI] 1.03-1.05); male sex (HR 1.40; 95% CI 1.08-1.81); log-transformed tumor size (HR 1.71; 95% CI 1.30-2.24); cardiovascular index (HR 1.48; 95% CI 1.32-1.67), and planned treatment (HR: 0.10, 95% CI: 0.06-0.18 for kidney-sparing intervention and HR: 0.20, 95% CI: 0.11-0.35 for radical nephrectomy vs. no intervention). The model achieved a C-statistic of 0.74 in the derivation cohort and 0.73 in the validation cohort. The model was well-calibrated at 1, 5, and 10 years of follow-up.
For patients with localized renal masses, accurate determination of life expectancy is essential for decision-making regarding intervention vs. active surveillance as a primary treatment modality. We have made available a simple tool for this purpose.
Urologic oncology. 2024 May 03 [Epub ahead of print]
Brian R Lane, Joseph G Cheaib, Dennis Boynton, Phillip Pierorazio, Sabrina L Noyes, Henry Peabody, Nirmish Singla, Anna Johnson, Khurshid R Ghani, Andrew Krumm, Karandeep Singh
Division of Urology, Corewell Health West, Grand Rapids, MI; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI. Electronic address: ., Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD., Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI., Division of Urology, University of Pennsylvania, Philadelphia, PA., Division of Urology, Corewell Health West, Grand Rapids, MI., Department of Urology, University of Michigan Medical School, Ann Arbor, MI., Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI., Department of Urology, University of Michigan Medical School, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI.