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Background <p>This study investigated the prognostic role of tumor necrosis (TN) in non-metastatic clear cell renal cell carcinoma (ccRCC).</p> Methods <p>We enrolled 1,212 non-metastatic ccRCC patients undergoing nephrectomy (2013–2023) in this retrospective study. Computer-generated randomization allocated cases to derivation (70%, <i>n</i> = 848) and validation cohorts (30%, <i>n</i> = 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).</p> Results <p>TN positivity was significantly associated with reduced OS (HR: 2.12, 95% CI: 1.65–2.73; <i>P</i> &lt; 0.001), CSS (HR: 2.45, 95% CI: 1.82–3.29; <i>P</i> &lt; 0.001), and RFS (HR: 1.89, 95% CI: 1.32–2.70; <i>P</i> = 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.</p> Conclusion <p>TN is an independent prognostic marker in non-metastatic ccRCC. The novel nomogram integrating TN provides reliable risk stratification, aiding personalized postoperative management.</p>

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Tumor necrosis-informed prognostic nomogram for clear cell renal cell carcinoma model development and clinical validation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月10日

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  • Zhiwei Guo,
  • Huiyu Zhou,
  • Dingyang Lv,
  • Zhao Hou,
  • Jinshuai Li,
  • Mohan Jia,
  • Hongyang Du,
  • Yingbo Kang,
  • Qiwei Wang,
  • Yabin Wang,
  • Luyue Kou,
  • Hanguang Fang,
  • Zhengkun Wang,
  • Weibing Shuang

摘要

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.