Outcome of patients with renal cell carcinoma nodal metastases (NM) is
substantially worse than that of patients with localized disease. This justifies
more thorough staging and possibly more aggressive treatment in those at risk of
or with established NM. We developed and externally validated a nomogram capable
of highly accurately predicting renal cell carcinoma NM in patients without
radiographic evidence of distant metastases. Age, symptom classification, tumour
size and the pathological nodal stage were available for 4,658 individuals. The
data of 2,522 (54.1%) individuals from 7 centers were used to develop a
multivariable logistic regression model-based nomogram predicting the individual
probability of NM. The remaining data from 2,136 (45.9%) patients from 5
institutions were used for external validation. In the development cohort,
107/2,522 (4.2%) had lymph node metastases vs. 100/2,136 (4.7%) in the external
validation cohort. Symptom classification and tumour size were independent
predictors of NM in the development cohort. Age failed to reach independent
predictor status, but added to discriminant properties of the model. A nomogram
based on age, symptom classification and tumour size was 78.4% accurate in
predicting the individual probability of NM in the external validation cohort.
Our nomogram can contribute to the identification of patients at low risk of NM.
This tool can help to risk adjust the need and the extent of nodal staging in
patients without known distant metastases. More thorough staging can hopefully
better select those in whom adjuvant treatment is necessary