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Background: The Heng et al JCO 2009 prognostic model was developed in the age of VEGF-targeted therapy and this study serves as an external validation while comparing its performance to other models. Methods: 1,028 previously unanalyzed patients were used to externally validate the prognostic criteria for overall survival (OS). The model’s discriminatory value was compared to four other prognostic models using C-indices and Net Reclassification Improvement (NRI) (Pencina et al 2008). NRI indicates how the Heng et al model improves upon other models by reclassifying a percentage of patients (pts) into the more correct risk group based on the observed OS at 2 years. Results: The median OS of all pts was 18.8 mons. On multivariable analysis, the pre-identified Heng’s risk factors (anemia, thrombocytosis, neutrophilia, hypercalcemia, Karnofsky performance status <80% and time from diagnosis to treatment < 1 year) continue to be independent predictors of poor OS (p<0.05). When pts were segregated into 3 risk categories, the median OS was 44, 21 and 8 mons in the favorable (17% of pts), intermediate (52%) and poor (31%) risk groups, respectively (p<0.0001, C-index=0.664). The NRI demonstrated that the Heng model was able to more accurately reclassify pts by a net of 23% and 9.7% of pts compared to the French and MSKCC models and was less accurate in reclassifying 13% of pts when compared to the CCF model (but lower c-index) based on observed 2-year OS (see table). Sensitivity analyses with 5 imputation datasets for missing data produced similar results. Conclusions: The Heng et al model was derived in the targeted therapy era and is now externally validated. The c-index is similar to other models primarily derived in the era of immunotherapy or early VEGF-targeted therapy.


Median OS in mons (% of pts)
Favorable Intermediate Poor C-index NRI*

Heng et al JCO 2009 44 (17%) 21 (52%) 8 (31%) 0.664
CCF (Choueiri Cancer 2007) 33 (34%) 18 (37%) 9 (29%) 0.662 -13%
French (Escudier ASCO 2008) 49 (5%) 21 (67%) 7 (28%) 0.638 23%
IKCWG (Royston ASCO 2007) 35 (14%) 24 (50%) 8 (36%) 0.668 3.2%
Motzer JCO 2002 44 (19%) 18 (59%) 7 (22%) 0.657 9.7%

*Comparing the Heng model with others.

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Author Details

D. Y. C. Heng

Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada

Abstract Details

Meeting

2011 ASCO Annual Meeting

Session Type

Poster Discussion Session

Session Title

Genitourinary (Nonprostate) Cancer

Track

Genitourinary Cancer

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Abstract Disclosure