The value of a postoperative nomogram based on the primary tumor score for overall survival of patients with renal cell carcinoma and inferior vena cava tumor thrombus

Rongjin Zhang; Zhuo Liu; Min Zhang; Nan Li; Chang Liu; Yongyue Zhang; Yang Sun; Shudong Zhang; Shumin Wang

doi:10.1016/j.urolonc.2024.10.031

The value of a postoperative nomogram based on the primary tumor score for overall survival of patients with renal cell carcinoma and inferior vena cava tumor thrombus

Urol Oncol. 2024 Nov 26:S1078-1439(24)00714-2. doi: 10.1016/j.urolonc.2024.10.031. Online ahead of print.

Authors

Rongjin Zhang¹, Zhuo Liu², Min Zhang³, Nan Li⁴, Chang Liu¹, Yongyue Zhang¹, Yang Sun¹, Shudong Zhang⁵, Shumin Wang⁶

Affiliations

¹ Department of Ultrasound, Peking University Third Hospital, Beijing, China.
² Department of Urology, Peking University Third Hospital, Beijing, China.
³ Department of Ultrasound, Second Hospital of Shanxi Medical University, Taiyuan, China.
⁴ Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.
⁵ Department of Urology, Peking University Third Hospital, Beijing, China. Electronic address: shootong@163.com.
⁶ Department of Ultrasound, Peking University Third Hospital, Beijing, China. Electronic address: shuminwang2014@163.com.

PMID: 39603877
DOI: 10.1016/j.urolonc.2024.10.031

Abstract

Background: Radical surgery can achieve remarkable improvements in the survival of patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus (IVCTT); however, not all patients can obtain the desired results. Therefore, identifying patients with poor survival after surgery is crucial for guiding follow-up adjuvant therapies and patient counseling.

Objective: To evaluate the impact of primary tumor score based on tumor necrosis and tumor thrombus morphology on overall survival (OS), and create a postoperative prognostic model for patients with RCC and IVCTT.

Methods: This retrospective study included 182 patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy (RNTE). Preoperative contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), ultrasound imaging, and clinical records were collected. Kaplan-Meier analysis was used to evaluate the overall survival (OS). Prognostic factors for OS were identified by univariate and multivariate analyses using the Cox proportional hazards regression model. A nomogram was developed and internally calibrated using the bootstrap resampling method.

Results: The mean follow-up time was 24.1 months (1-84.5 months), and 34.1% (62 of 182) of the patients died of all causes. The primary tumor score possesses a superior prognostic value for the primary tumor compared with the level of IVCTT and tumor size. Multivariate Cox regression analysis showed that primary tumor score, distant metastasis, nonclear cell subtype, sarcomatoid degeneration, preoperative anemia grade, and ASA level were independent prognostic factors. Based on these factors, a nomogram was built; the concordance index was 0.77, and the AUC for predicting 1-3 years OS were 0.80, 0.81, and 0.78, respectively.

Conclusions: Primary tumor score is a independent prognostic factors for patients with RCC and IVCTT. Combined with 5 easily acquired prognostic factors, a postoperative nomogram was developed and internally validated, and can be used to select patients who may benefit from adjuvant therapy or aggressive surveillance regimens.

Keywords: Inferior vena cava tumor thrombus; Nomogram; Primary tumor score; Prognosis; Renal cell carcinoma.