The RENAL nephrometry nomogram: statistically significant, but is it clinically relevant?

摘要

There are multiple treatment options for managing patients with renal cell carcinoma (RCC), particularly for those with a small renal mass (SRM). Surgical removal is the gold standard for treatment of localized RCC, whereas energy-ablative therapies and active surveillance are reasonable options in patients with significant comorbid medical conditions. The objective of preoperative prognostic stratification is to tailor an individual's therapy based on anticipated outcomes of a specific biologic factor. Preoperative identification of two such factors, malignancy or high-grade malignancy, would be useful when counseling a patient with a newly diagnosed SRM. An individual's risk can be assessed based on a single variable or through integration of multiple variables and calculating risk using a nomogram. The use of nomograms in urologic oncology has been driven by the allure of providing individualized medicine and optimizing clinical decision making based on a multitude of patient-specific variables rather than by simplistic grouping according to risk level.