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External validation of the RENAL nephrometry score nomogram for predicting high-grade renal cell carcinoma in solid, enhancing, and small renal masses

 Kyo Chul Koo  ;  Hanna Yoo  ;  Tae Young Shin  ;  Jongchan Kim  ;  Young Deuk Choi  ;  Koon Ho Rha  ;  Won Sik Ham 
 WORLD JOURNAL OF UROLOGY, Vol.32(1) : 249-255, 2014 
Journal Title
Issue Date
Aged ; Carcinoma, Renal Cell/diagnosis* ; Carcinoma, Renal Cell/pathology ; Carcinoma, Renal Cell/surgery ; Female ; Humans ; Kidney/pathology* ; Kidney Neoplasms/diagnosis* ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery ; Male ; Middle Aged ; Neoplasm Staging ; Nephrectomy ; Nomograms* ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies
Carcinoma ; Renal cell ; Nomograms ; Validation studies
PURPOSE: To confirm predictive accuracies of the RENAL nephrometry score (RNS) nomogram for identifying malignancy and high-grade renal cell carcinoma (RCC) in an external cohort of small renal masses (SRMs). METHODS: A total of 1,129 patients who underwent extirpative renal surgery for solid and enhancing cT1 renal tumors between 2005 and 2012 at a single institution were included in the validation cohort. A single uro-radiologist utilized computed tomography image reconstruction to classify tumors according to the RNS. The area under the curve (AUC) and calibration plots were used to determine predictive accuracies of malignancy and high-grade models of the RNS nomogram. RESULTS: Malignant and high-grade tumors were identified in 1,012 (89.6%) and 389 (38.4%) patients with cT1 tumors, and in 658 (87.3%) and 215 (32.6%) patients with cT1a tumors, respectively. Predictive performances of the nomogram for malignancy and high-grade models revealed AUCs of 0.722 and 0.574 for cT1 tumors, and 0.727 and 0.495 for cT1a tumors, respectively. The predictive value of the malignancy model was comparable to that of the model-development cohort (AUC = 0.76); however, the predictive value of the high-grade model was inferior to that of the model-development cohort (AUC = 0.73). CONCLUSIONS: Unlike previous validation studies, we report inferior predictive performance of the RNS nomogram for discriminating high-grade RCC in solid and enhancing SRMs. This suggests that the RNS nomogram may be unreliable for preoperatively predicting high-grade RCC in SRMs, in which tumor size, the key determinant of high-grade RCC, is a limiting factor.
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1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Koo, Kyo Chul(구교철) ORCID logo https://orcid.org/0000-0001-7303-6256
Kim, Jong Chan(김종찬) ORCID logo https://orcid.org/0000-0002-0022-6689
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Shin, Tae Young(신태영)
Yoo, Han Na(유한나)
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
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