A SEER Database Based Prognostic Model For Nomogram Prognosis After Nephrectomy In Patients With Metastatic Renal Cell Carcinoma

Objective: In this era of targeted molecules,the treatment of metastatic renal cell carcinoma（m RCC）has undergone a major change.Can cytoreductive nephrectomy（CN）provide some survival benefits for m RCC patients.The benefits remain to be studied.This study aims to explore the prognostic factors of m RCC patients receiving CN and construct a Nomogram prognostic model.Methods: The US SEER*Stat software（Version 8.3.5）was used to collect the SEER（Surveillance,Epidemiology,and End Results）database from the 2005-2016 clinical data of patients who were clearly diagnosed as m RCC and received CN.According to the diagnosis period,they were divided into two categories.Model cohort and validation cohort.A total of 3804 patients diagnosed in 2005-2011 were used as the modeling cohort to construct the predictive model,while the remaining 2085 patients diagnosed in 2012-2016 were used to construct the validation cohort.The variables were subjected to univariate and multivariate Cox analysis,the final independent risk factors were incorporated into the Cox proportional hazard model,and the modeling cohort was used to construct preoperative and postoperative Nomograms for predicting the 1-year,2-year,and 3-year survival rates of m RCC patients.The Bootstrap method was used to repeat 1000 samplings to internally verify the modeling queue,and the verification queue was externally verified.The consistency index（C-index）,the AUC area under the ROC curve,and the calibration curve were used to verify its accuracy.Finally,according to the preoperative Nomogram model score,the modeling cohort was divided into high and low risk two groups,and Kaplan-Meier survival analysis was performed with m RCC patients who did not undergo CN surgery.Results: Cox analysis showed that age,race,tumor location,tumor size,T staging,N staging,pathological type,grade classification,surgical method,whether to perform other operations,distant metastasis,and whether to undergo postoperative radiotherapy is the patient’s postoperative Risk factors for survival were included in the postoperative Nomogram.The C-index indexes of the modeling and verification cohorts were 0.669（95%CI: 0.659-0.679）and 0.676（95%CI: 0.666-0.686）,respectively;age,race,and tumor Location,tumor size,T stage,N stage,pathological type,grade grade,and distant metastasis were included in the preoperative Nomogram.The C-index index of the modeling and verification cohort was 0.662（95%CI:0.653-0.672）,0.672（95%CI: 0.663–0.682）.According to Kaplan-Meier survival analysis,compared with m RCC patients who have not undergone CN,patients with high-risk and low-risk preoperative scores receive certain survival benefits from CN.Conclusions: We constructed for the first time a line plot that predicts postoperative survival in patients with m RCC,and the results show that patients with m RCC can derive potential survival benefits from CN,although there are some limitations,but can help surgeons make decisions on treatment,as well as assess the prognosis of patients.