SAN DIEGO, CA USA (UroToday.com) - Patients with metastatic kidney cancer are often candidates for cytoreductive nephrectomy (CN), with previously published guidelines such as good performance status, absence of brain metastases, and majority of disease bulk contained within the affected kidney. Stratifying this unique group of patients to predict post-operative survival may be of great use for patient counseling and treatment planning.
Dr. Samuel Kaffenberger and colleagues presented an updated nomogram predicting mortality after CN. One-hundred thirty-five consecutive patients undergoing CN were included, based on the MSKCC pre-treatment prognostic models. Post-operative serum markers and Stage, Size, Grade, Necrosis (SSIGN) scores were combined and adjusted for use of targeted therapy. Laboratory results were collected at 6-8 weeks post-operatively, before initiation of targeted therapy. Multivariable Cox proportional hazards model was utilized, with missing data multiply imputed and model internally validated with bootstrapping.
Their analysis identified post-operative anemia, elevated lactate dehydrogenase (LDH) and number of metastatic sites, and increasing SSIGN score to be associated with increased mortality after CN. The final nomogram predicts survival at 1, 3, and 5 years, as well as median survival, and yields a C-index of 0.75. Pending external validation may prove to be a valuable clinical tool.
Presented by Samuel Kaffenberger, Pengcheng Lu, Todd Morgan, Tatsuki Koyama, Dominic Tang, Jacob Ark, Daniel Barocas, Sam Chang, Michael Cookson, Duke Herrell, and Peter Clark at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Serge Ginzburg, MD
