Highly predictive survival nomogram after upper urinary tract urothelial carcinoma

Abstract

BACKGROUND: Nephroureterectomy is the surgical standard of care for patients with upper urinary-tract urothelial carcinoma. The objectives of the current study were to identify the most informative predictors of cancer-specific mortality after nephroureterectomy, to devise an algorithm capable of predicting the individual probability of cancerspecific mortality, and to compare its prognostic accuracy to that of the International Union Against Cancer (UICC) staging system. METHODS: Within the Surveillance, Epidemiology, and End Results database, the authors identified 5918 patients who had been treated with nephroureterectomy. Within the development cohort (n ¼ 2959), multivariate Cox regression models predicting cancer-specific mortality were fitted by using age, stage, nodal status, sex, grade, race, type of surgery (nephroureterectomy with or without bladder-cuff removal), and tumor location (renal pelvis vs ureter). Backward variable elimination according to the Akaike information criterion identified the most accurate and parsimonious model. Model validation and calibration were performed within the external validation cohort (n ¼ 2959). External validation was also applied to the UICC staging system. RESULTS: The 5-year freedom from cancer-specific mortality rates in both the development and external validation cohorts was 77.3%. The most informative and parsimonious nomogram for cancer-specific-mortality-free survival relied on age, pT and pN stages, and tumor grade. In external validation, nomogram prediction of 5-year cancer-specific-mortality-free rate was 75.4% accurate and was significantly better (P < .001) than the UICC staging system (64.8%). CONCLUSIONS: The current nomogram is capable of predicting the prognosis in patients with upper urinary-tract urothelial carcinoma treated by nephroureterectomy with better accuracy than the UICC staging system. The authors recommend the application of this nomogram to routine clinical practice when counseling or making clinical decisions. Cancer 2010;116:3774-84.

Effect of preoperative chemotherapy on survival of patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes

“…2 validated a few small retrospective studies including ours, [3][4][5] and confirmed that preoperative chemotherapy and subsequent consolidative surgery could offer survival improvement in patients with UTUC clinically…”

“…[3][4][5] As the majority of these patients developed metastases after RNU, UTUC involving regional LN can be considered a systemic disease. These patients require multidisciplinary treatment, but the strategy for their treatment has not been determined.…”

“…[3][4][5] In this condition, patients require multidisciplinary treatment, although the adequate strategy has not been determined. Only a few retrospective studies reported that preoperative chemotherapy and subsequent RNU for node-positive UTUC was associated with better oncological outcomes compared with primary surgery.…”

The role of American Society of Anesthesiologists scores in predicting urothelial carcinoma of the upper urinary tract outcome after radical nephroureterectomy: results from a national multi‐institutional collaborative study

“…In various collective forms, they have been incorporated into nomogram models to predict either CSS [ 17 ] or disease stage at time of NU [ 18 ] .…”

804 Promising role of preoperative neutrophil-to-lymphocyte ratio in patients treated with radical nephroureterectomy

“…We performed a multivariable analysis using most of the clinicopathologic parameters published in the literature [3,23,24]. When we limited our multivariable analysis to the parameters used in established prognostic models [3,[23][24][25], NLR did not demonstrate independent prognostic value, however (data not shown). Third, populations were different regarding the clinicopathologic characteristics.…”