신세포암에 대한 근치적 수술 후 무재발 생존의 예후 인자 및 예측 노모그램

Purpose: This multiinstitutional study was to investigate the accuracy of the Kattan nomograms for the prediction of recurrence after definitive surgery for renal cell carcinoma (RCC) in Korean patients and develop a nomogram revised to complement the shortcomings.<BR> Materials and Methods: Clinical and pathological data of 1,866 patients with RCC who had been followed for at least 2 years after surgery in each participating institutes were reviewed as well as evidence of disease recurrence, defined to include local recurrence and distant metastasis. Accuracy of the Kattan nomograms` predictability in tumors 7cm or less was tested by calculating the area under the receiver-operating characteristics curve (AUC) and actuarial recurrence-free survival by Kaplan-Meier method. We used the Cox proportional hazard analysis to identify significant variables and develop prediction nomogram, and internally validated by bootstrapping method. Mean follow-up was 56.5 months (24-184).<BR> Results: Recurrence occurred in 12.5% of the patients and correlated with the pathological stage, with 4.3%, 7.9%, 15.0%, 22.6%, 38.4%, 58.3% for stages T1a, T1b, T2, T3a, T3b/c and T4, respectively (p＜0.001). The AUC of the Kattan nomograms was 0.276. Factors significantly predictive of recurrence were T stage (p＜0.0001), presentation (p＝0.006), preoperative hemoglobin (p＝0.023) and gender (p＝0.032). Actuarial 60-month recurrencefree survival was 87.9% and using the prognostic factors, nomogram predicting 60-month recurrence-free survival was constructed.<BR> Conclusions: Korean nomogram complementing the preexisting nomograms for the prediction of recurrence-free survival after definitive surgery for RCC has been constructed, which may be useful in patient prognostication, counseling and follow-up planning.