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Liao Z, Wang D, Song N, Xu Y, Ge H, Peng Z. Prognosis of clear cell renal cell carcinoma patients stratified by age: A research relied on SEER database. Front Oncol 2022; 12:975779. [PMID: 36313677 PMCID: PMC9597499 DOI: 10.3389/fonc.2022.975779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/21/2022] [Indexed: 12/24/2022] Open
Abstract
ObjectiveClear cell renal cell carcinoma may affect patients of any age. To date, there are only a limited number of large data studies on renal clear cell carcinoma in different age groups. This study assessed CCRCC risk factors in different age groups using the Surveillance Epidemiology and End Results (SEER) database.MethodsWe selected 58372 cases from the SEER database. These patients were divided into seven different age groups. Cox regression models were used to find independent risk factors for the survival of CCRCC patients. Based on independent risk factors, a nomogram was drawn with R software. Kaplan-Meier method for survival analysis and X-tile software were used to find the optimal age group for diagnosis.ResultsUnivariate analysis revealed that patients’ age, sex, race, marital status, grade, TNM (tumor, node, metastasis) stage, surgery, WHO/ISUP grade were correlated with survival (P<0.01). Age was an independent risk factor for survival in patients with CCRCC according to multivariate Cox regression analysis (p<0.01). All-cause mortality and tumor-specific mortality increased according to the increasing age of the patients. The optimal cut-off values for age were defined as 58 and 76 years and 51 and 76 years, respectively, according to overall survival (OS) and cause-specific survival (CSS).ConclusionThere is a negative correlation between age and survival of CCRCC patients. The difference in prognosis of patients in different age groups has important implications for clinical treatment. Therefore, the diagnosis and treatment plan should be based on more detailed age grouping, which is more beneficial to improving the prognosis and survival of patients.
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Affiliation(s)
- Zhouning Liao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Dang Wang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Ning Song
- Division of Translational Immunology, III, Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yang Xu
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heming Ge
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Zhangzhe Peng, ; Heming Ge,
| | - Zhangzhe Peng
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Zhangzhe Peng, ; Heming Ge,
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Wang J, Tang J, Chen T, Yue S, Fu W, Xie Z, Liu X. A web-based prediction model for overall survival of elderly patients with early renal cell carcinoma: a population-based study. J Transl Med 2022; 20:90. [PMID: 35164796 PMCID: PMC8845298 DOI: 10.1186/s12967-022-03287-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Background The number of elderly patients with early renal cell carcinoma (RCC) is on the rise. However, there is still a lack of accurate prediction models for the prognosis of early RCC in elderly patients. It is necessary to establish a new nomogram to predict the prognosis of elderly patients with early RCC. Methods The data of patients aged above 65 years old with TNM stage I and II RCC were downloaded from the SEER database between 2010 and 2018. The patients from 2010 to 2017 were randomly assigned to the training cohort (n = 7233) and validation cohort (n = 3024). Patient data in 2018(n = 1360) was used for external validation. We used univariable and multivariable Cox regression model to evaluate independent prognostic factors and constructed a nomogram to predict the 1-, 3-, and 5-year overall survival (OS) rates of patients with early-stage RCC. Multiple parameters were used to validate the nomogram, including the consistency index (C-index), the calibration plots, the area under the receiver operator characteristics (ROC) curve, and the decision curve analysis (DCA). Results The study included a total of 11,617 elderly patients with early RCC. univariable and multivariable Cox regression analysis based on predictive variables such as age, sex, histologic type, Fuhrman grade, T stage, surgery type, tumors number, tumor size, and marriage were included to establish a nomogram. The C-index of the training cohort and validation cohort were 0.748 (95% CI: 0.760–0.736) and 0.744 (95% CI: 0.762–0.726), respectively. In the external validation cohort, C-index was 0.893 (95% CI: 0.928–0.858). The calibration plots basically coincides with the diagonal, indicating that the observed OS was almost equal to the predicted OS. It was shown in DCA that the nomogram has more important clinical significance than the traditional TNM stage. Conclusion A novel nomogram was developed to assess the prognosis of an elderly patient with early RCC and to predict prognosis and formulate treatment and follow-up strategies.
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Fukushima H, Saito K, Yasuda Y, Tanaka H, Patil D, Cotta BH, Patel SH, Master VA, Derweesh IH, Fujii Y. Female Gender Predicts Favorable Prognosis in Patients With Non-metastatic Clear Cell Renal Cell Carcinoma Undergoing Curative Surgery: Results From the International Marker Consortium for Renal Cancer (INMARC). Clin Genitourin Cancer 2019; 18:111-116.e1. [PMID: 32001181 DOI: 10.1016/j.clgc.2019.10.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 10/19/2019] [Accepted: 10/28/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is no clear consensus regarding gender differences in the prognosis of patients with clear-cell renal cell carcinoma (ccRCC). In the present study, we investigated the prognostic value of gender in patients with non-metastatic ccRCC undergoing curative surgery using the inverse probability of treatment weighting (IPTW) method to balance the difference in baseline factors between females and males. PATIENTS AND METHODS We retrospectively reviewed the International Marker Consortium for Renal Cancer (INMARC) dataset and included 2055 patients with cT1-4N0M0 ccRCC who underwent partial or radical nephrectomy. The IPTW method was used to adjust for baseline characteristics between females and males (age, race, surgery type, and pT stage), and the association of gender with recurrence-free survival (RFS) was evaluated. RESULTS During the follow-up (median, 30 months), 162 (8%) patients had disease recurrence (5-year RFS rate, 88%). Female gender (n = 712; 35%) was significantly associated with a lower Fuhrman grade (unweighted, P = .022; IPTW-weighted, P < .001). Females had significantly better RFS compared with males (unweighted, 5-year RFS rate, 92% vs. 87%; P = .005; IPTW-weighted, 5-year RFS rate, 92% vs. 86%; P = .002). IPTW-weighted multivariate analysis showed that female gender was an independent predictor for better RFS (hazard ratio, 0.59; P = .005) along with lower pT stage and lower Fuhrman grade. The prognostic significance of female gender was also observed in the unweighted multivariate analysis. CONCLUSION Female gender was significantly associated with a lower Fuhrman grade and better prognosis for patients with non-metastatic ccRCC undergoing curative surgery.
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Affiliation(s)
- Hiroshi Fukushima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yosuke Yasuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Brittney H Cotta
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA
| | - Sunil H Patel
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Ithaar H Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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Cai M, Wei J, Zhang Z, Zhao H, Qiu Y, Fang Y, Gao Z, Cao J, Chen W, Zhou F, Xie D, Luo J. Impact of age on the cancer-specific survival of patients with localized renal cell carcinoma: martingale residual and competing risks analysis. PLoS One 2012; 7:e48489. [PMID: 23119034 PMCID: PMC3484053 DOI: 10.1371/journal.pone.0048489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 09/26/2012] [Indexed: 11/18/2022] Open
Abstract
Background Age at diagnosis has been shown to be an independent prognostic factor of localized renal cell carcinoma (RCC) in several studies. We used contemporary statistical methods to reevaluate the effect of age on the cancer-specific survival (CSS) of localized RCC. Methods and Findings 1,147 patients with localized RCC who underwent radical nephrectomy between 1993 and 2009 were identified in our four institutions. The association between age and CSS was estimated, and the potential threshold was identified by a univariate Cox model and by martingale residual analysis. Competing risks regression was used to identify the independent impact of age on CSS. The median age was 52 years (range, 19–84 years). The median follow-up was 61 months (range, 6–144 months) for survivors. A steep increasing smoothed martingale residual plot indicated an adverse prognostic effect of age on CSS. The age cut-off of 45 years was most predictive of CSS on univariate Cox analysis and martingale residual analysis (p = 0.005). Age ≤45 years was independently associated with a higher CSS rate in the multivariate Cox regression model (HR = 1.59, 95% CI = 1.05–2.40, p = 0.027) as well as in competing risks regression (HR = 3.60, 95% CI = 1.93–6.71, p = 0.001). Conclusions Increasing age was associated with a higher incidence of cancer-specific mortality of localized RCC. Age dichotomized at 45 years would maximize the predictive value of age on CSS, and independently predict the CSS of patients with localized RCC.
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Affiliation(s)
- Muyan Cai
- Department of Urology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-Sen University, Guangzhou, China
| | - Jinhuan Wei
- Department of Urology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhiling Zhang
- Department of Urology, Cancer Center, Sun Yat-Sen University, Guangzhou, China
| | - Hongwei Zhao
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University Medical College, Yantai, China
| | - Yunqiao Qiu
- Department of Urology, First Affiliated Hospital, GuangZhou University of Chinese Medicine, Guangzhou, China
| | - Yong Fang
- Department of Urology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhenli Gao
- Department of Urology, Affiliated Yantai Yuhuangding Hospital, Qingdao University Medical College, Yantai, China
| | - Jiazheng Cao
- Department of Urology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei Chen
- Department of Urology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Fangjian Zhou
- Department of Urology, Cancer Center, Sun Yat-Sen University, Guangzhou, China
| | - Dan Xie
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-Sen University, Guangzhou, China
- * E-mail: (DX); (JHL)
| | - Junhang Luo
- Department of Urology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- * E-mail: (DX); (JHL)
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Abouassaly R, Alibhai SM, Tomlinson G, Timilshina N, Finelli A. Unintended Consequences of Laparoscopic Surgery on Partial Nephrectomy for Kidney Cancer. J Urol 2010; 183:467-72. [DOI: 10.1016/j.juro.2009.10.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Robert Abouassaly
- Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, Management and Evaluation (SMHA, GT, NT), University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M.H. Alibhai
- Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, Management and Evaluation (SMHA, GT, NT), University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, Management and Evaluation (SMHA, GT, NT), University of Toronto, Toronto, Ontario, Canada
| | - Narhari Timilshina
- Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, Management and Evaluation (SMHA, GT, NT), University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, Management and Evaluation (SMHA, GT, NT), University of Toronto, Toronto, Ontario, Canada
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