Prognostic Nomograms and Aggtrmmns Scoring System for Predicting Overall Survival and Cancer-specific Survival of Patients with Kidney Cancer

Background: Currently, the prognosis of kidney cancer depends mainly on the pathological grade or tumor stage. Clinicians have few effective tools that can personalize and adequately evaluate the prognosis of kidney cancer patients.

Methods: A total of 70 481 kidney cancer patients were selected from the Surveillance, Epidemiology, and End Results database, among which patients diagnosed in 2005-2011 (n = 42 890) were used to establish nomograms for overall survival (OS) and cancer-specific survival (CSS), and those diagnosed in 2012-2015 (n = 24 591) were used for external validation. Univariate and multivariate Cox analyses were used to determine independent prognostic factors. Concordance index (C-index), receiver operating characteristic curve, and calibration curve were used to evaluate the predictive capacity of the nomograms. We further reduced subgroup classification and used propensity score matching to balance clinical informations, and analyzed the effect of other variables on survival. We established a new kidney cancer prognostic score system based on the effect of all available variables on survival. Cox proportional hazard model and Kaplan-Meier curves were used for survival comparison.

Results: Age, gender, marital status, surgery, grade, T stage, and M stage were included as independent risk factors in the nomograms. The favorable area under the curve (AUC) value (for OS, AUC = 0.812-0.858; and for CSS, AUC = 0.890-0.921), internal (for OS, C-index = 0.776; and for CSS, C-index = 0.856), and external (for OS, C-index = 0.814-0.841; and for CSS, C-index = 0.894-0.904) validation indicated that the proposed nomograms could accurately predict 1-, 3-, and 5-year OS and CSS of kidney cancer patients. The Aggtrmmns prognostic scoring system based on age, gender, race, marital status, grade, TNM stage, and surgery of kidney cancer patients could stage patients more explicitly than the AJCC staging system.

Conclusion: The nomogram and Aggtrmmns scoring system can predict OS and CSS in kidney cancer patients effectively, which may help clinicians personalize prognostic assessments and clinical decisions.