Development and Validation of Prognostic Nomogram for Young Patients with Kidney Cancer

Abstract

Background

The aim of this study was to establish a nomogram model to evaluate the prognosis of early-onset kidney cancer (EOKC) in terms of overall survival (OS) and cancer-specific survival (CSS).

Methods

Patients with EOKC diagnosed between 2004 and 2015 were collected from Surveillance, Epidemiology and End Results (SEER) and randomly assigned to the training and validation set at a ratio of 2 to 1. Important variables for constructing nomograms were screened by univariate and multivariate Cox analysis. The nomogram model was evaluated using concordance index (C-index), decision curve analysis (DCA) curves, and receiver operating characteristic (ROC) curves.

Results

A total of 12,526 EOKC patients were included in the study. OS nomogram was constructed based on gender, age, race, grade, AJCC stage, TNM stage, histology, chemotherapy and radiotherapy. CSS nomogram was constructed based on listed above except gender. In the external validation, the C-index for the OS nomogram was 0.855 (95% CI 0.834–0.976), and the C-index for the CSS nomogram was 0.938 (0.925–0.951). High-quality calibration curves were noted in both OS and CSS nomogram models. ROC and DCA curves showed that nomograms had better predictive performance than TNM stage and SEER stage.

Conclusion

The nomogram model provides an applicable tool for evaluating the OS and CSS prognosis of EOKC.

Keywords:

• early-onset kidney cancer
• nomogram
• OS
• CSS
• SEER

Abbreviations

EOKC, early-onset kidney cancer; ccRCC, clear-cell renal cell carcinoma; SEER, Surveillance, Epidemiology and End Results; AJCC, American Joint Committee on Cancer; OS, overall survival; CSS, cancer-specific survival; HR, hazard ratios; CI, confidence interval.

Ethical Statement

This article does not contain any studies with human participants or animals performed by any of the authors. The patient information in the SEER database is anonymized and publicly available, and our study was not monitored by an institutional review board. The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgments

The authors are grateful for the invaluable support and useful discussions with other members of the general surgery department.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (No.6590000186) and the Natural Science Foundation of Jiangsu Province (BK20200360).