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Can the Kattan nomogram still accurately predict prognosis in renal cell carcinoma using the revised 2010 tumor–nodes–metastasis reclassification?
Author(s) -
Veeratterapillay Rajan,
Rakhra Simren,
ElSherif Amira,
Johnson Mark,
Soomro Naeem,
Heer Rakesh
Publication year - 2012
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/j.1442-2042.2012.03008.x
Subject(s) - nomogram , medicine , nephrectomy , renal cell carcinoma , metastasis , pathological , stage (stratigraphy) , oncology , t stage , cancer , clear cell renal cell carcinoma , primary tumor , urology , kidney , paleontology , biology
The Kattan nomogram has been used in renal cell cancer to predict progression‐free survival after nephrectomy. Tumor–nodes–metastasis staging is essential for the calculation of this score. The effect of the recent 2010 revision to the tumor–nodes–metastasis classification on the predictive ability of the Kattan nomogram was studied. All patients having radical nephrectomy for renal cell cancer in the 5‐year period of 2004–2008 at a tertiary referral center were included. Pathological and radiological records were reviewed to identify tumor–nodes–metastasis stage (2002 and 2010 classifications). Kattan scores were calculated for the 2002 and 2010 tumor–nodes–metastasis stages, and the effect on survival predictions were compared with actual outcomes. A total of 291 patients with non‐metastatic renal cell cancer were identified. Revision of the tumor–nodes–metastasis staging from the 2002 to 2010 classification resulted in an increase in the number of patients with stage pT3a (from 30 to 75), a reduction in the patients with stage pT3b (from 57 to 10) and a small increase in stage pT4 cases (1 to 3). This altered the proportion of patients in the Kattan prognostic of “good” (from 61% to 69%), “intermediate” (from 29% to 22%) and “poor” (from 10% to 8%). The overall median predicted 5‐year progression‐free survival was 79.8% with 2002 tumor–nodes–metastasis, and 81.8% with 2010 tumor–nodes–metastasis. Actual 5‐year progression‐free survival was 83.0%, which was not significantly different from that predicted using either tumor–nodes–metastasis classification ( P = 0.66). On comparing the new 2010 and old 2002 tumor–nodes–metastasis classification in our cohort, we showed the predictive ability of the Kattan nomogram remained unaltered.