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PubMed1988

Assessment of maximal tubular phosphate reabsorption: comparison of direct measurement with the nomogram of Bijvoet.

It is well established that plasma phosphate (Pp) is largely determined by the renal phosphate threshold, which is best described by the maximal rate of tubular phosphate reabsorption divided by the glomerular filtration rate (Tmp/GFR). For its clinical assessment either direct phosphate loading with simultaneous measurement of GFR is performed, or the nomogram described by Walton and Bijvoet is used. In order to test the validity of the two methods, we compared in 20 infants and 31 children the fasting values of phosphate reabsorption [endogenous phosphate reabsorption/inulin clearance (Tp/Cin) and Tp] with those obtained after phosphate loading [maximal phosphate reabsorption (Tmp) and Tmp/Cin], and both with those derived from the nomogram. In addition the fasting Tp/Cin of 50 infants and 143 children could be compared with the nomogram. The results demonstrate that the directly measured Tp/Cin was the same as the directly measured Tmp/Cin and that the measured Tmp/Cin was correctly estimated by the nomogram. However, the comparison of fasting Tp/Cin with nomogram-derived values showed a systematic error, by which the latter values were higher than those measured. The discrepancy was due to the splay of the phosphate titration curve, which was found by Bijvoet when the ratio of phosphate clearance (Cp) corrected for GFR (Cp/GFR) fell below 0.2. The incorporation of this splay in the nomogram could not be confirmed by data measured in our children. It is concluded that fasting Tp is already "maximal" and that, therefore, no phosphate loading is necessary to estimate Tmp. Furthermore, there is no evidence of a major splay, which makes the nomogram incompatible below a Cp/GFR ratio of 0.2.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗

PubMed1989

Evaluation of the validity of the Done nomogram in the management of acute salicylate intoxication.

To evaluate the validity of the Done nomogram in the management of acute adult salicylate intoxications, a retrospective review of cases at our institution was performed. The degree of severity (ie, asymptomatic, mild, moderate, or severe) as determined by plotting the serum concentration and time on the nomogram for 55 acute salicylate intoxications was compared with the degree of severity decided on by three experienced emergency physicians who based their decision on the clinical presentation of the cases and the original criteria devised by Done for each category of severity. Discordant classifications between the nomogram and the physicians provided a basis on which a predictive index for the nomogram and various subsets of cases could be determined. The calculated predictive index for the nomogram was 0.42, with the highest predictive index of 0.79 in the mild salicylate category. The nomogram tends to overpredict the severity of intoxication in the moderate and severe categories. There was no significant difference between predictive indexes of mixed versus nonmixed or enteric-coated acetylsalicylic acid versus plain acetylsalicylic acid cases, although the nomogram had a higher predictive index when used for concentrations drawn six to 12 hours after ingestion (P less than .01, Fisher's exact test). Decisions on management of an acute salicylate overdose should be based on clinical presentation and good judgment as well as the serum salicylate concentration in relation to the time of ingestion.

Adult↗

PubMed2002

Nomograms for clinically localized prostate cancer. Part II: radiation therapy.

Prostate cancer can be effectively treated with either external beam radiation techniques or with brachytherapy. This study was designed to address the methodology that is used to assess outcome data in the current radiation literature and to evaluate available nomograms that can be used to predict outcomes. A literature search was performed and 12 articles reviewed. Risk stratification was the most frequently used methodology to analyze data. This method encompasses disease-specific variables: the pretreatment prostate-specific antigen (PSA) value and the Gleason score are classified by using cut points into low, intermediate, and high-risk groups. Another methodology uses nomograms to predict outcome. The nomogram uses continuous values of each variable so that the outcome probability for a specific set of parameters is quite specific. The advantage of nomogram analysis over risk stratification analysis is presented. In conclusion, only 3 reports were identified in the radiation literature that used a nomogram to predict outcome. One of the nomograms is proprietary and difficult to interpret. The other 2 nomograms, 1 for 3-dimensional radiation and the other for brachytherapy, have been incorporated into hand-held devices that can be used at consultation with the patient to discuss outcome probabilities to assist in treatment decisions.

Algorithms↗

PubMed1997

An evaluation of empiric vs. nomogram-based dosing of heparin in an intensive care unit.

OBJECTIVE: To compare the time to achieve therapeutic anticoagulation with heparin using two dosing methods. DESIGN: A retrospective before and after time series. SETTING: An 11-bed medical-surgical intensive care unit of a tertiary, teaching hospital. PATIENTS: Critically ill patients who required full dose anticoagulation as part of treatment of hemodynamic or respiratory failure. INTERVENTION: The use of a weight-based dosing nomogram with independent adjustment of infusion rates by nursing staff utilizing the nomogram dosing directions. This nomogram was compared with prior empiric heparin dosing by physicians. MEASUREMENTS AND MAIN RESULTS: The time to achieve a therapeutic activated partial thromboplastin time (PTT) (> 60 secs) was significantly less during use of the nomogram than during use of the empiric dosing method. The number of adjustments required to achieve the therapeutic PTT was less during use of the nomogram. Heparin dosing using the nomogram resulted in larger initial heparin infusion rates (unit/kg) and significantly higher initial PTT results. There was no difference in the initial bolus dose, time to first measured PTT, number of PTT measurements outside the therapeutic range, or signs of toxicity from subtherapeutic or supratherapeutic anticoagulation. CONCLUSIONS: Use of a weight-based heparin dosing nomogram by intensive care unit nursing staff can shorten the time to achieve therapeutic anticoagulation compared with empiric dosing by physicians.

Anticoagulants↗

PubMed2002

International validation of a preoperative nomogram for prostate cancer recurrence after radical prostatectomy.

PURPOSE: We evaluated the predictive accuracy of a recently published preoperative nomogram for prostate cancer that predicts 5-year freedom from recurrence. We applied this nomogram to patients from seven different institutions spanning three continents. METHODS: Clinical data of 6,754 patients were supplied for validation, and 6,232 complete records were used. Nomogram-predicted probabilities of 60-month freedom from recurrence were compared with actual follow-up in two ways. First, areas under the receiver operating characteristic curves (AUCs) were determined for the entire data set according to several variables, including the institution where treatment was delivered. Second, nomogram classification-based risk quadrants were compared with actual Kaplan-Meier plots. RESULTS: The AUC for all institutions combined was 0.75, with individual institution AUCs ranging from 0.67 to 0.83. Nomogram predictions for each risk quadrant were similar to actual freedom from recurrence rates: predicted probabilities of 87% (low-risk group), 64% (intermediate-low-risk group), 39% (intermediate-high-risk group), and 14% (high-risk group) corresponded to actual rates of 86%, 64%, 42%, and 17%, respectively. The use of neoadjuvant therapy, variation in the prostate-specific antigen recurrence definitions between institutions, and minor differences in the way the Gleason grade was reported did not substantially affect the predictive accuracy of the nomogram. CONCLUSION: The nomogram is accurate when applied at international treatment institutions with similar patient selection and management strategies. Despite the potential for heterogeneity in patient selection and management, most predictions demonstrated high concordance with actual observations. Our results demonstrate that accurate predictions may be expected across different patient populations.

Adult↗

PubMed2001

An institution-specific heparin titration nomogram: development, validation, and assessment of compliance.

STUDY OBJECTIVE: To develop, validate, and assess compliance with a heparin titration nomogram. DESIGN: Prospective, open-label trial. SETTING: University teaching hospital. SUBJECTS: Patients admitted with heart failure who required therapy with intravenous unfractionated heparin. Intervention. An in vitro concentration-response was determined by measuring activated partial thromboplastin times (aPTTs) on normal pooled plasma containing known concentrations of heparin. The therapeutic aPTT range was determined from the concentration-response by using the therapeutic heparin concentration range of 0.2-0.4 U/ml (protamine neutralization). Patients were consecutively enrolled, and therapy was managed by using the heparin titration nomogram. Paired aPTT-heparin concentrations were obtained, and nomogram validation was performed by comparing the in vitro and the ex vivo concentration-responses with use of linear regression. Nomogram compliance also was assessed. MEASUREMENTS AND MAIN RESULTS: The therapeutic aPTT ranges based on in vitro and ex vivo data were determined to be 45-72 seconds and 47-61 seconds, respectively. The ranges were significantly different (p<0.001). Overall compliance with the nomogram was 88%. CONCLUSION: These results confirm that, even in a relatively homogeneous disease-state patient population, in vitro data do not accurately predict ex vivo data. If in vitro data are used to develop an institution-specific nomogram, a validation procedure should be used to ensure accuracy. Although 100% compliance to a nomogram may not be attainable, it should be expected. Therefore, a compliance rate of 88% is concerning and suggests a need for increased nursing and physician education.

Anticoagulants↗

PubMed2001

[Therapeutic infusion of heparin. Application of a nomogram correlated with weight].

We performed a retrospective study to determine whether the use of a nomogram in General Medicine Wards is superior to the empiric method for the adjustment of heparin dosage. In the period october 1998-september 1999 we treated 138 patients with continuous infusion of heparin using a weight-based nomogram. Then we compared these data (nomogram group) with data from period october 1997-september 1998, when we had treated 155 patients with heparin, using empiric method for dose adjustments (empiric group). The proportion of patients reaching the therapeutic aPTT 24 hours after the start of therapy was 90.5% in nomogram group compared with 56.1% in the empiric group (P < 0.001). The proportion of nontherapeutic and subtherapeutic aPTT was significantly reduced in the nomogram group (6.0% vs. 11.1%, P < 0.001; 13.7% vs. 19.3%, P < 0.001). Furthermore, in the nomogram group the proportion of consecutive nontherapeutic or overtherapeutic values were significantly reduced (0.1% vs. 2.2%, P < 0.001; 1.8% vs. 2.3%, P < 0.001). We conclude that a weight-based heparin nomogram adapted for own aPTT range is successfully used in General Medical Wards of a community hospital.

Adolescent↗

PubMed2004

[The evaluation of bladder outlet obstruction using the bladder weight calculation nomogram].

The ultrasound estimated bladder weight (UEBW) of 15 patients (13 male, 2 female; mean age 64.7 years) who underwent pressure flow study (PFS) were evaluated using the nomogram. In the nomogram, thickness of bladder wall (T) and bladder weight (BW) were plotted on the horizontal axis and on the vertical axis, respectively. BW points calculated from various values of T by the formula were plotted on the volume-fixed bladder capacity curve. BW of each case was estimated by the nomogram from echo-measured T at maximum bladder filling and injected volume (V) into the bladder. Bladder outlet obstruction (BOO): was evaluated from obtained results, and compared with the results of PFS. The features of the distribution on Schafer's nomogram were also investigated. It was possible to estimate BW immediately after ultrasonic examination. BW was under 35 g in one patient, and over 35 g in 14 patients. Obstruction grade on the Schafer's nomogram ranged from III to VI. BOO could be evaluated quantitatively with little invasion even in patients who could not undergo PFS for urinary retention and urge incontinence. In conclusion, the bladder weight calculation nomogram immediately showed the BOO information of the patient with neither invasive technique, complicated calculation, electronic calculator nor expansive computer. This nomogram may make a breakthrough for utilizing UEBW.

Adult↗

PubMed1991

Nomogram for dosing warfarin at steady state.

The predictive performance of a nomogram for dosing warfarin was compared with that of a computer program. The nomogram and the computer program were developed from the log-linear model describing warfarin pharmacodynamics at steady state. The nomogram's dose-response curves were generated by using previously reported pharmacodynamic and pharmacokinetic values for an outpatient population receiving warfarin. The series of dose-response curves were plotted by altering the pharmacodynamic values over a range of 3 standard deviations. The ability of the nomogram to predict the steady-state prothrombin time ratio (PTR) after an adjustment in the dosage of warfarin was evaluated, and the results were compared with those of a commercially available program involving Bayesian regression. Data for 65 outpatients were evaluated. The mean +/- S.D. nomogram-predicted, computer-predicted, and measured PTRs were 1.63 +/- 0.27, 1.64 +/- 0.24, and 1.66 +/- 0.23, respectively. The mean prediction errors for the nomogram and the computer program were -0.037 and -0.026, respectively, and the mean percent absolute prediction errors were 11.6% and 11.0%, respectively. Neither method was biased, and differences between the results for the two methods were not significant. The predictive performance of the warfarin dosing nomogram was comparable to that of the computer program.

Bayes Theorem↗

PubMed2006

Postoperative nomogram predicting risk of recurrence after radical cystectomy for bladder cancer.

PURPOSE: Radical cystectomy and pelvic lymphadenectomy (PLND) remains the standard treatment for localized and regionally advanced invasive bladder cancers. We have constructed an international bladder cancer database from centers of excellence in the management of bladder cancer consisting of patients treated with radical cystectomy and PLND. The goal of this study was the development of a prognostic outcomes nomogram to predict the 5-year disease recurrence risk after radical cystectomy. PATIENTS AND METHODS: Institutional radical cystectomy databases containing detailed information on bladder cancer patients were obtained from 12 centers of excellence worldwide. Data were collected on more than 9,000 postoperative patients and combined into a relational database formatted with patient characteristics, pathologic details of the pre- and postcystectomy specimens, and recurrence and survival status. Patients with available information for all selected study criteria were included in the formation of the final prognostic nomogram designed to predict 5-year progression-free probability. RESULTS: The final nomogram included information on patient age, sex, time from diagnosis to surgery, pathologic tumor stage and grade, tumor histologic subtype, and regional lymph node status. The predictive accuracy of the constructed international nomogram (concordance index, 0.75) was significantly better than standard American Joint Committee on Cancer TNM (concordance index, 0.68; P < .001) or standard pathologic subgroupings (concordance index, 0.62; P < .001). CONCLUSION: We have developed an international bladder cancer nomogram predicting recurrence risk after radical cystectomy for bladder cancer. The nomogram outperformed prognostic models that use standard pathologic subgroupings and should improve our ability to provide accurate risk assessments to patients after the surgical management of bladder cancer.

Adenocarcinoma↗

PubMed2004

Validation of the postoperative nomogram for 12-year sarcoma-specific mortality.

BACKGROUND: On the basis of a prospectively followed cohort of adult patients with primary soft tissue sarcoma (STS) who were treated at Memorial Sloan-Kettering Cancer Center (MSKCC; New York, NY), a nomogram for predicting sarcoma-specific mortality was developed. Although this nomogram was found to be accurate by internal validation tests, it had not been validated in an external patient cohort, and thus its universal applicability remained unproven. METHODS: Between 1975 and 2002, 1167 adult patients (age > or = 16 years) underwent treatment for primary STS at the University of California-Los Angeles (UCLA; Los Angeles, CA). All patients treated with an ifosfamide-based chemotherapy protocol (n = 238) were excluded from the current analysis. The remaining 929 patients constituted the population on which the validation study was performed. The nomogram validation process comprised two activities. First, the extent of discrimination was quantified using the concordance index. Second, the level of calibration was assessed by grouping patients with respect to their nomogram-predicted mortality probabilities and then comparing group means with observed Kaplan-Meier estimates of disease-specific survival. RESULTS: With median follow-up intervals of 48 months for all patients and 60 months for surviving patients, the 5-year and 10-year disease-specific survival rates were 77% (95% confidence interval [CI], 74-80%) and 71% (95% CI, 67-75%), respectively. Application of the nomogram to the UCLA data set yielded a concordance index of 0.76, and the observed correspondence between predicted and actual outcomes suggested a high level of calibration. CONCLUSIONS: In the current study, the MSKCC Sarcoma Nomogram was found to provide accurate survival predictions when it was applied to an external cohort of patients who were treated at UCLA.

Adolescent↗

PubMed2006

Low predictive accuracy of the Kattan postoperative nomogram for renal cell carcinoma recurrence in a population of French patients.

BACKGROUND: The aim of the current study was to establish the predictive accuracy of the Kattan postoperative nomogram for nonmetastatic renal cell carcinoma (RCC) by comparing predictions with actual disease recurrence in patients who underwent surgery in a single center in France. METHODS: Between 1985 and 2000, 844 patients were treated for RCC. The following data were collated: age, symptoms, histology, tumor size, grade, TNM 1997 stage, recurrence, and progression. For each patient a prognostic score (predicted probability) for recurrence-free survival (RFS) at 5 years was calculated using the Kattan nomogram. The discriminating ability of the model was assessed by Harrell's concordance index (c-index). Bootstrapping was used to assess confidence intervals. Furthermore, survival was then estimated by the Kaplan-Meier method and Cox proportional hazards regression analysis. RESULTS: In all, 565 patients (median age, 62 years) were included. At the time of the last follow-up, 81 patients had died and 101 had experienced RCC recurrence. The c-index for RFS (Kattan nomogram) was only 0.607 (95% confidence interval [CI]: 0.576-0.635). The 5-year RFS rate and cancer-specific survival rate were 81.5% and 84.7%, respectively. Of the 4 variables included in the nomogram, only TNM stage was associated with recurrence in a multivariate analysis (Cox analysis) (P = .022). CONCLUSIONS: There was a discrepancy between predicted RFS as estimated by the Kattan nomogram and the likelihood of being recurrence-free at 5 years according to the Cox analysis in the current population of patients. However, until new dynamic models become available clinicians may still improve their predictive ability by using the current nomogram.

Carcinoma, Renal Cell↗

PubMed2006

[Nomograms for the improvement of refractive outcomes].

BACKGROUND: Nomograms are efficient tools to improve the predictability of refractive procedures by using statistical methods to analyze pre- and postoperative refractive data. The purpose of this work was to analyze the clinical relevance and limitations of nomograms in a case series. METHODS: Computer simulations based on the known unpredictability for refractive outcomes were performed for three different distribution functions of the preoperative refractions. In addition, the clinical applicability was investigated in three different cohorts that underwent laser in situ keratomileusis (LASIK). RESULTS: The use of individual nomograms significantly improves the predictability of the refractive outcome. However, theoretical investigation demonstrates that a homogeneous data distribution within cohorts is a key factor for predictable nomogram calculations. Outliers within the cohorts are not integrated into the nomogram calculation due to the mathematical model used. CONCLUSIONS: Nomograms are helpful for improving refractive outcomes. However, they are currently limited to approximately 90% within +/-0.5 D.

Adolescent↗

PubMed2006

Development and external validation of an extended 10-core biopsy nomogram.

OBJECTIVES: To test the accuracy of a previously externally validated sextant biopsy nomogram in referred men exposed to > or =10 or more biopsy cores. Moreover, we explored the hypothesis that a more accurate predictive tool could be developed. METHODS: Previous nomogram predictors (age, digital rectal examination, prostate-specific antigen, and percent free PSA) were used to assess the accuracy of our previous nomogram in a cohort consisting of 2900 men referred for prostatic evaluation. Moreover, these variables were complemented with sampling density (SD) (i.e., ratio of gland volume and the number of planned biopsy cores) within multivariable logistic regression models (LRM) predicting presence of prostate cancer (pCA) on the initial 10 or more core biopsy. The LRMs were used to develop and internally validate (200 bootstrap resamples) a new nomogram in 1162 men from Hamburg, Germany. The LRMs' external validity was tested in three separate cohorts (Hamburg, n=582; Milan, n=961; Seattle, n=195). RESULTS: The contemporary external validation of the previously validated sextant nomogram demonstrated 70% accuracy. Internal validation of the new nomogram demonstrated 77% accuracy, and external cohorts demonstrated 73-76% accuracy. CONCLUSIONS: In the era of extended biopsy schemes, previously developed predictive models are less accurate in predicting the probability of pCA on initial biopsy. We developed a new tool that allows obtaining more accurate predictions. Moreover, before biopsy, it also allows defining the ideal ratio between gland volume and the number of planned biopsy cores that would yield the ideal biopsy rate.

Adult↗

PubMed2006

Nomogram for predicting disease recurrence after radical cystectomy for transitional cell carcinoma of the bladder.

PURPOSE: American Joint Committee on Cancer staging represents the gold standard for prediction of recurrence after radical cystectomy in patients with invasive bladder cancer. We tested the hypothesis that American Joint Committee on Cancer stage based predictions may be improved when pathological tumor and node stage information is combined with additional clinical and pathological variables within a prognostic nomogram. MATERIALS AND METHODS: We used Cox proportional hazards regression analysis to model variables of 728 patients with transitional cell carcinoma of the bladder treated with radical cystectomy and bilateral pelvic lymphadenectomy at 1 of 3 participating institutions. Standard predictors, pT and pN, were complemented by age, gender, tumor grade at cystectomy, presence of lymphovascular invasion, presence of carcinoma in situ in the cystectomy specimen, neoadjuvant chemotherapy, adjuvant chemotherapy and adjuvant radiotherapy. The concordance index was used to quantify the accuracy of regression coefficient based nomograms. A total of 200 bootstrap resamples were used to reduce overfit bias and for internal validation. Calibration plots were used to graphically explore the performance characteristics of the multivariate nomogram. RESULTS: Followup ranged from 0.1 to 183.4 months (median 24.9, mean 36.4). Recurrence was recorded in 249 (34.2%) patients with a median time to recurrence of 108 months (range 0.8 to 131.9). Actuarial recurrence-free probabilities were 69.6% (95% CI 65.8%-73.0%), 60.2% (55.8%-64.3%) and 52.9% (47.3%-58.1%) at 2, 5 and 8 years after cystectomy, respectively. Two-hundred bootstrap corrected predictive accuracy of American Joint Committee on Cancer stage based predictions was 0.748. Accuracy increased by 3.2% (0.780) when age, lymphovascular invasion, carcinoma in situ, neoadjuvant chemotherapy, adjuvant chemotherapy and adjuvant radiotherapy were added to pathological stage information and used within a nomogram. CONCLUSIONS: A nomogram predicting bladder cancer recurrence after cystectomy is 3.2% more accurate than American Joint Committee on Cancer stage based predictions. Moreover, a nomogram approach combines several advantages such as easy and precise estimation of individual recurrence probability at key points after cystectomy, which all patients deserve to know and all treating physicians need to know.

Adult↗

PubMed2006

Validation of a nomogram for prediction of side specific extracapsular extension at radical prostatectomy.

PURPOSE: We have previously have reported a tree structured regression model for predicting SS-ECE. Others recently reported a logistic regression based SS-ECE nomogram. We developed a nomogram and compared the performance and discriminant properties of the tree regression and the nomogram in a contemporary cohort of European patients treated with radical retropubic prostatectomy. MATERIALS AND METHODS: The cohort consisted of 1,118 patients with pretreatment prostate specific antigen 0.1 to 73.2 ng/ml (median 6.6). Each of the 2,236 prostate lobes was considered separately. Clinical stage, pretreatment PSA, biopsy Gleason sum, percent positive cores and percent cancer in the biopsy specimen were used as predictors in a logistic regression model predicting SS-ECE. Regression coefficients were then used to generate an SS-ECE nomogram. Performance characteristics and discriminant properties of the previously published tree regression were also tested in the same cohort. For internal validation and to decrease overfit bias 200 bootstrap re-samples were applied to accuracy estimates for each method. RESULTS: ECE was present in 303 of 1,118 radical retropubic prostatectomy specimens (27%) and in 385 lobes (17%). In logistic regression models all variables were statistically significant multivariate predictors of SS-ECE except the percent of positive biopsy cores (p = 0.7). Bootstrap corrected predictive accuracy of the SS-ECE nomogram was 0.840 vs 0.700 for the tree regression model. CONCLUSIONS: Logistic regression based nomogram predictions of SS-ECE are highly accurate and represent a valuable aid for assessing the risk of ECE prior to surgery.

Calibration↗

PubMedDate not supplied

Collaborative development of an insulin nomogram for intensive insulin therapy.

A significant reduction in morbidity and mortality can be achieved by using intensive insulin therapy to achieve normoglycemia in the critically ill patient. Nurses hourly titrate insulin infusion rates using protocols, most often in chart form, to guide practice. Despite the reported development of several intensive insulin protocols, information about the accuracy, practicality, ease of calculation, and preferences of critical care nurses have not been studied. The purpose of this study was to test a newly developed nomogram to determine if it was clinically practical, easily understood, and more quickly and accurately used than existing protocols in chart form. Three cohorts of nurses (N = 153), with an average of 9 years experience in critical care, performed calculations of insulin doses on the basis of hypothetical patient data, using chart and nomogram protocols. Time, accuracy, preference, and feedback were examined over all 3 phases. No statistical significance was found between the chart and nomogram methods regarding time to complete the calculations nor was there any significant effect of experience on the time it took to complete the calculations or the accuracy of the resultant answers. Overall, the accuracy of the calculations improved with each revision of the nomogram. The nurses did not have a preference of one tool over another but gave extensive feedback that helped refine the nomogram. The resultant nomogram was shown to be easy to use, helpful in improving the accuracy of insulin dosage calculation, and judged to be practical by the nurses who would use the tool at the bedside.

Algorithms↗

PubMed2005

A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma.

PURPOSE: Few published studies have simultaneously analyzed multiple prognostic factors to predict recurrence after surgery for conventional clear cell renal cortical carcinomas. We developed and performed external validation of a postoperative nomogram for this purpose. We used a prospectively updated database of more than 1,400 patients treated at a single institution. MATERIALS AND METHODS: From January 1989 to August 2002, 833 nephrectomies (partial and radical) for renal cell carcinoma of conventional clear cell histology performed at Memorial Sloan-Kettering Cancer Center were reviewed from the center's kidney database. Patients with von Hippel-Lindau disease or familial syndromes, as well as patients presenting with synchronous bilateral renal masses, or distant metastases or metastatic regional lymph nodes before or at surgery were excluded from study. We modeled clinicopathological data and disease followup for 701 patients with conventional clear cell renal cell carcinoma. Prognostic variables for the nomogram included pathological stage, Fuhrman grade, tumor size, necrosis, vascular invasion and clinical presentation (ie incidental asymptomatic, locally symptomatic or systemically symptomatic). RESULTS: Disease recurrence was noted in 72 of 701 patients. Those patients without evidence of disease had a median and maximum followup of 32 and 120 months, respectively. The 5-year probability of freedom from recurrence for the patient cohort was 80.9% (95% confidence interval 75.7% to 85.1%). A nomogram was designed based on a Cox proportional hazards regression model. Following external validation predictions by the nomogram appeared accurate and discriminating, and the concordance index was 0.82. CONCLUSIONS: A nomogram has been developed that can be used to predict the 5-year probability of freedom from recurrence for patients with conventional clear cell renal cell carcinoma. This nomogram may be useful for patient counseling, clinical trial design and effective patient followup strategies.

Carcinoma, Renal Cell↗