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• W2320492775 abstract "You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging I1 Apr 2016MP73-11 A COMPREHENSIVE COMPETING RISK CALCULATOR FOR PATIENTS WITH CORTICAL RENAL MASSES < 10CM: A NOVEL CLINICAL DECISION AID FOR SHARED DECISION-MAKING REGARDING INDIVIDUALIZED TREATMENT SELECTION Sarah Psutka, Michael Jewett, Kamel Fadaak, Antonio Finelli, R. Houston Thompson, Jeph Herrin, Christine Lohse, Stephen Boorjian, Suzanne Stewart-Merrill, Thomas Atwell, Grant Schmit, Brian Costello, Laura Legere, Nilay Shah, and Bradley Leibovich Sarah PsutkaSarah Psutka More articles by this author , Michael JewettMichael Jewett More articles by this author , Kamel FadaakKamel Fadaak More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Jeph HerrinJeph Herrin More articles by this author , Christine LohseChristine Lohse More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , Suzanne Stewart-MerrillSuzanne Stewart-Merrill More articles by this author , Thomas AtwellThomas Atwell More articles by this author , Grant SchmitGrant Schmit More articles by this author , Brian CostelloBrian Costello More articles by this author , Laura LegereLaura Legere More articles by this author , Nilay ShahNilay Shah More articles by this author , and Bradley LeibovichBradley Leibovich More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1666AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Treatment options for patients with cortical renal masses (CRM) include radical or partial nephrectomy (RN or PN), ablation, or active surveillance (AS). Existing nomograms have yet to incorporate treatment modality. Using a large multi-institutional cohort, we constructed comprehensive nomograms to predict renal cell carcinoma-specific (CSM) and other-cause mortality (OCM) following different treatment options, to inform individualized counseling of patients regarding treatment selection. METHODS Preoperative clinical and radiological features were collected for 3079 patients treated at two academic centers (2000-10) for localized (cT1-2aNx/0Mx/0) CRM. Median follow-up was 6.3 years. We applied a random forest algorithm for competing risks to identify the most important predictors for CSM and OCM. Forward stepwise inclusion by order of importance scores identified final survival models for each outcome and Harrell′s C-statistics were calculated. We re-estimated these two models within treatment groups to construct survival estimates up to 5 years. RESULTS The cohort comprised of patients treated as follows: RN: 977; PN: 1531; Ablation: 409; AS: 162. Estimated overall 5-year cancer-specific and OCM-free survival were 96.5% and 89.8% respectively. The variables most predictive of CSM were clinical T stage, baseline hematocrit, pre-diagnosis weight loss, and tumor size (C-statistics 75.8% - 98.3% across treatment groups). The preoperative features most associated with OCM were Charlson Comorbidity Index, age, ECOG performance status, presence of other malignancies, ASA score, eGFR, pretreatment hematocrit, cardiac disease, and neutrophil-to-lymphocyte ratio (C-statistics 76.4% - 83.8% across treatment groups). Figure 1 depicts output of the nomograms for a sample patient. CONCLUSIONS We present a competing risk calculator that incorporates easily obtained pretreatment features to quantify competing causes of mortality in patients with localized CRM by treatment option. This tool can provide patients with estimated individualized probabilities of competing causes of death by treatment option, to facilitate shared-decision making. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e964-e965 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sarah Psutka More articles by this author Michael Jewett More articles by this author Kamel Fadaak More articles by this author Antonio Finelli More articles by this author R. Houston Thompson More articles by this author Jeph Herrin More articles by this author Christine Lohse More articles by this author Stephen Boorjian More articles by this author Suzanne Stewart-Merrill More articles by this author Thomas Atwell More articles by this author Grant Schmit More articles by this author Brian Costello More articles by this author Laura Legere More articles by this author Nilay Shah More articles by this author Bradley Leibovich More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ..." @default.
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• W2320492775 title "MP73-11 A COMPREHENSIVE COMPETING RISK CALCULATOR FOR PATIENTS WITH CORTICAL RENAL MASSES < 10CM: A NOVEL CLINICAL DECISION AID FOR SHARED DECISION-MAKING REGARDING INDIVIDUALIZED TREATMENT SELECTION" @default.
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