AUA 2018: Development of a Predictive Nomogram to Predict Overall Survival Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

San Francisco, CA ( The authors presented a study aiming to design a nomogram to predict patient-specific overall survival in upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU).

A total of 239 patients who underwent RNU between 1998 and 2017 were included in the analysis. Detailed demographic, past medical, perioperative and pathological variables were collected. A risk score was assigned for each predictor according to the average of Odds ratios if the p-value was less than 0.05 in more than 50% of the time in multivariable analysis. 

There were 99 deaths in the study cohort. On multivariable analysis age, positive surgical margins. ASA, hydronephrosis, tumor grade, sarcomatoid features, LVI, LN status and metastatic status were significant predictors of overall survival.

A score was assigned to each predictor (hydronephrosis -1, ASA3-1, surgical margin -2, high grade - 2, sarcomatoid - 3 and LVI - 1). A total score was developed (0-10) and this resulted in five risk categories with distinct survival outcomes (Table 1). Survival curves for each category are shown in Figure 1. 

Table 1. Five Year Mortality for Different Risk Categories
              Five Year Mortality for Different Risk Categories

Overall Survival

The authors concluded that this nomogram can be used to predict OS in UTUC without the need for expensive or additional testing. Naturally, further studies to validate this model are needed.

Presented by: Haidar Abdul-Muhsin, MBChB. Mayo Clinic Arizona, Phoenix, AZ, US
Co-Authors: Noel Delucia, Vijay Singh, Stephen Cha, Anojan Navaratnam, Mark Tyson, Thai Ho, Erik Castle, Phoenix, AZ

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA