PURPOSE: Based on data retrieved from a comprehensive multicenter database, we externally validated a published postoperative nomogram for the prediction of disease-specific survival (DSS) in patients with papillary renal cell carcinoma (papRCC). METHODS: A multicenter database containing data of 2325 patients with surgically treated papRCC was used as validation cohort. After exclusion of patients with missing data and patients included in the development cohort, 1372 patients were included in the final analysis. DSS-probabilities according to the nomogram were calculated and compared to actual DSS-probabilities. Subsequently, calibration plots and decision curve analyses were applied. RESULTS: The median follow-up was 38 months (IQR 11.8-80.7). Median DSS was not reached. The c-index of the nomogram was 0.71 (95% CI 0.60-0.83). A sensitivity analysis including only patients operated after 1998 delivered a c-index of 0.84 (95% CI 0.77-0.92). Calibration plots showed slight underestimation of nomogram-predicted DSS in probability ranges below 90%: median nomogram-predicted 5-year DSS in the range below 90% was 55% (IQR 20-80), but the median actual 5-year DSS in the same group was 58% (95% CI 52-65). Decision-curve analysis showed a positive net-benefit for probability ranges between a DSS probability of 5% and 85%. CONCLUSIONS: The nomogram performance was satisfactory for almost all DSS probabilities; hence it can be recommended for application in clinical routine and for counseling of patients with papRCC.

Centre of Urological Surgery Dialysis and Renal Transplantation Fundeni Clinical Institute Bucharest Romania

Department of Urology Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust Hills Road Cambridge CB2 0QQ UK

Department of Urology ASL Abruzzo2 Chieti Italy

Department of Urology ASL Abruzzo2 S Pio da Pietrelcina Hospital Vasto Italy

Department of Urology Elblandklinikum Riesa Weinbergstrasse 8 01589 Riesa Germany

Department of Urology Faculty of Medicine Charles University Pilsen Czech Republic

Department of Urology Hospital Bad Saarow Bad Saarow Germany

Department of Urology Instituto Nacional de Cancerologia INCan Mexico City Mexico

Department of Urology Klinikum St Elisabeth Straubing Germany

Department of Urology LMU Munich Grosshadern Munich Germany

Department of Urology Medical University of Graz Graz Austria

Department of Urology San Raffaele Scientific Institute Milan Italy

Department of Urology University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany

Department of Urology University Hospital Greifswald Greifswald Germany

Department of Urology University Hospital Mainz Mainz Germany

Department of Urology University Hospital Mannheim Mannheim Germany

Department of Urology University Hospital Muenster Muenster Germany

Division of Experimental Oncology Unit of Urology URI IRCCS San Raffaele Hospital Milan Italy

Hospital Clínic University of Barcelona Barcelona Spain

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