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Tumor necrosis-informed prognostic nomogram for clear cell renal cell carcinoma model development and clinical
Zhiwei Guo1,2, Huiyu Zhou1,2, Dingyang Lv1,2
1Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China.
Background:
This study investigated the prognostic role of tumor necrosis (TN) in non-metastatic clear cell renal cell carcinoma (ccRCC).
Methods:
We enrolled 1,212 non-metastatic ccRCC patients undergoing nephrectomy (2013-2023) in this retrospective study. Computer-generated randomization allocated cases to derivation (70%, n = 848) and validation cohorts (30%, n = 364). Kaplan-Meier methodology compared overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) across TN-positive and TN-negative cohorts, with intergroup differences evaluated by log-rank testing. Prognostic determinants were identified through univariate and multivariate Cox proportional hazards regression. We developed a prognostic nomogram through stepwise Cox regression that integrated TN status with key clinicopathological variables. Validation employed: Harrell's C-index, time-dependent ROC curves, calibration plots, and decision curve analysis (DCA).
Results:
TN positivity was significantly associated with reduced OS (HR: 2.12, 95% CI: 1.65-2.73; P < 0.001), CSS (HR: 2.45, 95% CI: 1.82-3.29; P < 0.001), and RFS (HR: 1.89, 95% CI: 1.32-2.70; P = 0.003) in multivariate analysis. The prognostic nomogram demonstrated excellent discrimination in the validation cohort, with C-indices of 0.855 (OS), 0.870 (CSS), and 0.724 (RFS). Time-dependent ROC analysis revealed robust predictive accuracy for OS at 1- (AUC: 0.892), 3- (AUC: 0.846), and 5-year (AUC: 0.826) intervals. Calibration curves demonstrated excellent consistency between predicted probabilities and actual outcomes. Decision curve analysis further revealed greater clinical net benefit than pT stage system and WHO/ISUP classification.
Conclusion:
TN is an independent prognostic marker in non-metastatic ccRCC. The novel nomogram integrating TN provides reliable risk stratification, aiding personalized postoperative management.
