Evaluating Overall Survival and Competing Risks of Death in Patients With Localized Renal Cell Carcinoma Using a Comprehensive Nomogram
- 10 January 2010
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 28 (2), 311-317
- https://doi.org/10.1200/jco.2009.22.4816
Abstract
Purpose Many patients with localized node-negative renal cell carcinoma (RCC) are elderly with competing comorbidities. Their overall survival benefit after surgical treatment is unknown. We reviewed cases in the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the impact of kidney cancer versus competing causes of death in patients with localized RCC and develop a comprehensive nomogram to quantitate survival differences. Methods We identified individuals with localized, surgically treated clear-cell, papillary, or chromophobe RCC in SEER (1988 through 2003). We used Fine and Gray competing risks proportional hazards regressions to predict 5-year probabilities of three competing mortality outcomes: kidney cancer death, other cancer death, and noncancer death. Results We identified 30,801 cases of localized RCC (median age, 62 years; median tumor size, 4.5 cm). Five-year probabilities of kidney cancer death, other cancer death, and noncancer death were 4%, 7%, and 11%, respectively. Age was strongly predictive of mortality and most predictive of nonkidney cancer deaths (P < .001). Increasing tumor size was related to death from RCC and inversely related to noncancer deaths (P < .001). Racial differences in outcomes were most pronounced for nonkidney cancer deaths (P < .001). Men were more likely to die than women from all causes (P < .002). This nomogram integrates commonly available factors into a useful tool for comparing competing risks of death. Conclusion Management of localized RCC must consider competing causes of mortality, particularly in elderly populations. Effective decision making requires treatment trade-off calculations. We present a tool to quantitate competing causes of mortality in patients with localized RCC.This publication has 43 references indexed in Scilit:
- Sensitivity analysis to investigate the impact of a missing covariate on survival analyses using cancer registry dataStatistics in Medicine, 2009
- Histopathological Characteristics of Localized Renal Cell Carcinoma Correlate With Tumor Size: A SEER AnalysisJournal of Urology, 2009
- Cryoablation or radiofrequency ablation of the small renal massCancer, 2008
- Cancer Statistics, 2008CA: A Cancer Journal for Clinicians, 2008
- A Nomogram Predicting 10-Year Life Expectancy in Candidates for Radical Prostatectomy or Radiotherapy for Prostate CancerJournal of Clinical Oncology, 2007
- Rising Incidence of Small Renal Masses: A Need to Reassess Treatment EffectJNCI Journal of the National Cancer Institute, 2006
- Using Protein Expressions to Predict Survival in Clear Cell Renal CarcinomaClinical Cancer Research, 2004
- A competing‐risks nomogram for sarcoma‐specific death following local recurrenceStatistics in Medicine, 2003
- A Proportional Hazards Model for the Subdistribution of a Competing RiskJournal of the American Statistical Association, 1999
- The Autopsy as a Measure of Accuracy of the Death CertificateThe New England Journal of Medicine, 1985