NODESAFE: Novel Nomogram Predicts Nodal Tropism for Patients With RCC

The use of lymphadenectomy for localized renal cell carcinoma (RCC) remains controversial. At the 24th Annual Meeting of the Society of Urologic Oncology, Dr. Cesare Saitta presented data on NODESAFE, a novel preoperative nomogram that was developed to predict nodal tropism (NT) at the time of, or following, nephrectomy. NT was defined as lymph node metastasis (NM) or invasion at the histological report site at follow-up, and NM was defined as the development of a new adenopathy larger than 10 mm as seen in a computed tomography (CT) scan at follow-up.

Using the International Marker Consortium for Renal Cancer database, a retrospective analysis was performed on patients with RCC who received primary surgical resection. A total of 2297 patients met the inclusion criteria; patients with clinical metastasis at presentation were excluded from the analysis.

The NODESAFE model was created using a stepwise multivariable logistic regression (MLR) model, and accuracy was tested with receiver operator characteristic estimated area under the curve (AUC). Internal validation was performed through cross validation analysis.

According to the MLR, independent predictors of NT included cN (odds ratio [OR], 5.90; P<.001), tumor size ≥6 cm (OR, 3.04; P<.001), preoperative c-reactive protein ≥8.5 mg/L (OR, 1.98; P=.011), preoperative neutrophile-lymphocyte ratio ≥2.5 (OR, 1.74; P=.034), low enhancement in CT imaging (OR, 2.05; P=.009), hypertension (OR, 2.78; P<.001), and Charlson Comorbidity Index ≥6 (OR, 2.57; P=.001). These variables were used to develop the NODESAFE model. After a cross validation analysis, the AUC was 0.87 and 0.84. NODESAFE demonstrated a 73.5% sensitivity rate, 84.5% specificity, and a 98.8% negative predictive value.

By combining clinical features, serum biomarkers, and radiographic findings, the NODESAFE model can accurately predict nodal tropism for patients with RCC. The model can aid in clinical decision-making and may spur consideration for adjuvant therapy.