Abstract
Background
Kidney cancer (KC) is one of the most common malignant tumors in adults which particularly affects the survival of elderly patients. We aimed to construct a nomogram to predict overall survival (OS) in elderly KC patients after surgery.
Methods
Information on all primary KC patients aged more than 65 years and treated with surgery between 2010 and 2015 was downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analysis was used to identify the independent prognostic factors. Consistency index (C-index), receiver operating characteristic curve (ROC), the area under curve (AUC), and calibration curve were used to assess the accuracy and validity of the nomogram. Comparison of the clinical benefits of nomogram and the TNM staging system is done by decision curve analysis (DCA) and time-dependent ROC.
Results
A total of 15,989 elderly KC patients undergoing surgery were included. All patients were randomly divided into training set (N = 11,193, 70%) and validation set (N = 4796, 30%). The nomogram produced C-indexes of 0.771 (95% CI 0.751–0.791) and 0.792 (95% CI 0.763–0.821) in the training and validation sets, respectively, indicating that the nomogram has excellent predictive accuracy. The ROC, AUC, and calibration curves also showed the same excellent results. In addition, DCA and time-dependent ROC showed that the nomogram outperformed the TNM staging system with better net clinical benefits and predictive efficacy.
Conclusions
Independent influencing factors for postoperative OS in elderly KC patients were sex, age, histological type, tumor size, grade, surgery, marriage, radiotherapy, and T-, N-, and M-stage. The web-based nomogram and risk stratification system could assist surgeons and patients in clinical decision-making.
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Data availability
The data for this study were obtained from publicly available databases (https://seer.cancer.gov/). The datasets analyzed or generated by this study are available from the corresponding author with appropriate reasons.
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DZ and LJ contributed to the conception and design of the study; LJ, CW, YT and JJ performed the experiments, collected and analyzed data; LJ wrote the manuscript; all authors reviewed and approved the final version of the manuscript.
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Jiang, L., Wang, C., Tong, Y. et al. Web-based nomogram and risk stratification system constructed for predicting the overall survival of older adults with primary kidney cancer after surgical resection. J Cancer Res Clin Oncol 149, 11873–11889 (2023). https://doi.org/10.1007/s00432-023-05072-8
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DOI: https://doi.org/10.1007/s00432-023-05072-8