Pavlos Msaouel: Misinterpretation of ASSURE Nomogram in Kidney Cancer Follow-Up
Pavlos Msaouel, Assistant Professor of Genitourinary Medical Oncology at MD Anderson Cancer Center, shared a post on X:
“This comes up in kidney cancer clinic every few months. And on patient groups just as often.
The ASSURE nomogram shows cumulative disease-free survival (DFS) from time 0 after surgery. Great info… until someone hits the 2-year mark and panics at that 48.8% 3-year number.
Key concept: conditional probability.
The table helps answer, “What are my chances of still being cancer-free if we start counting at surgery?”. But once you’ve already made it to 2 years, you’ve cleared a big hurdle and the math has to adjust.
Here’s how:
P(DFS ≥3 yr | DFS ≥ yr) = P( 0.488 | 0.587) = 0.831. That’s an 83 % chance of staying disease-free for another year—not 49%!
Same trick for longer horizons:
10-yr DFS at the 5-yr milestone: 0.220 / 0.365=0.375≈60.3%. Way better than the 22% you might fear when staring at the raw table.
Numbers aren’t the enemy—they just need the right lens. Next time a survivorship stat looks scary, ask: “What does this mean given where I am today?” Conditional thinking can turn dread into perspective.”
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