Logical Imputation to Optimize Prognostic Risk Classification in Metastatic Renal Cell Cancer
Kidney Cancer, vol. 6, pp. 169–178
Abstract
BACKGROUND: Application of the MSKCC and IMDC models is recommended for prognostication in metastatic renal cell cancer (mRCC). Patient classification in MSKCC and IMDC risk groups in real-world observational studies is often hampered by missing data on required pre-treatment characteristics. OBJECTIVE: To evaluate the effect of application of easy-to-use logical, or deductive, imputation on MSKCC and IMDC risk classification in an observational study setting. PATIENTS AND METHODS: We used data on 713 mRCC patients with first-line sunitinib treatment from our observational European multi-centre study EuroTARGET. Pre-treatment characteristics and follow-up were derived from medical files. Hospital-specific cut-off values for laboratory measurements were requested. The effect of logical imputation of missing data and consensus versus hospital-specific cut-off values on patient classification and the subsequent models’ predictive performance for progression-free and overall survival (OS) was evaluated. RESULTS: 45% of the patients had missing data for≥1 pre-treatment characteristic for either model. Still, 72% of all patients could be unambiguously classified using logical imputation. Use of consensus instead of hospital-specific cut-offs led to a shift in risk group for 12% and 7% of patients for the MSKCC and IMDC model, respectively. Using logical imputation or other cut-offs did not influence the models’ predictive performance. These were in line with previous reports (c-statistic ∼0.64 for OS) CONCLUSIONS: Logical imputation leads to a substantial increase in the proportion of patients that can be correctly classified into poor and intermediate MSKCC and IMDC risk groups in observational studies and its use in the field should be advocated.
Authors 19
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Radboud University Medical Center
Affiliation as printed
Radboud University Medical Center, Nijmegen, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Radboud University Medical Center, Nijmegen, The Netherlands
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Leiden University Medical Center · Princess Máxima Center
Affiliation as printed
Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Carol Davila University of Medicine and Pharmacy
Affiliation as printed
University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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Research Institute Hospital 12 de Octubre · Hospital Universitario 12 De Octubre
Affiliation as printed
Medical Oncology Department, Hospital Universitario 12 de Octubre, I + 12 Research Institute, (CiberOnc), Madrid, Spain
Medical Oncology Department, Hospital Universitario 12 de Octubre, + 12 Research Institute, (CiberOnc), Madrid, Spain
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Affiliation as printed
Medical Oncology, HM Hospitales-Centro Integral Oncológico HM Clara Campal, Madrid, Spain
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Complejo Hospitalario de Navarra
Affiliation as printed
Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, Spain
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Leiden University Medical Center
Affiliation as printed
Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation as printed
Institute of Pharmacy, Department of Clinical Pharmacy, University of Bonn, Bonn, Germany
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Jena University Hospital · Saarland University
Affiliation as printed
Clinic of Urology and Paediatric Urology, Saarland University, Homburg, Germany
Department of Urology, Jena University Hospital, Jena, Germany
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Institut d'Investigació Biomédica de Bellvitge · Institut Català d'Oncologia · Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol
Affiliation as printed
Cancer Epigenetics and Biology Program, Bellvitge Biomedical Research Institute, Barcelona, Catalonia, Spain
Institut Catala d’Oncologia (ICO), Badalona Applied Research Group in Oncology (B-ARGO Group), Institut Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
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Carol Davila University of Medicine and Pharmacy · Spitalul Clinic de Nefrologie Dr. Carol Davila
Affiliation as printed
Spitalul Clinic de Nefrologie “Dr. Carol Davila”, Bucharest, Romania
University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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Spanish National Cancer Research Centre · Centre for Biomedical Network Research on Rare Diseases
Affiliation as printed
Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO) and Biomedical Network on Rare Diseases (CIBERER), Madrid, Spain
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Central European Society for Anticancer Drug Research
Affiliation as printed
CESAR Central Office, CESAR Central European Society for Anticancer Drug Research-EWIV, Vienna, Austria
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Cambridge University Hospitals NHS Foundation Trust
Affiliation as printed
Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
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Cambridge University Hospitals NHS Foundation Trust
Affiliation as printed
Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
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Radboud University Medical Center
Affiliation as printed
Radboud University Medical Center, Nijmegen, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Radboud University Medical Center, Nijmegen, The Netherlands
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Sita H. H. M. Vermeulen corresponding
Radboud University Medical Center
Affiliation as printed
Radboud University Medical Center, Nijmegen, The Netherlands
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