SUO 2017: Preoperative Multiplex Nomogram For Prediction Of high-risk non-organ confined Upper-Tract Urothelial Carcinoma

Washington, DC ( Introduction: Radical nephroureterectomy (RNU) is the gold standard for management of upper-tract urothelial carcinoma (UTUC). The authors attempted to generate a preoperative tool to optimize predictive accuracy for high-risk non-organ confined (NOC)-UTUC.

Methods: This was a retrospective evaluation of 652 patients undergoing surgical excision of UTUC at 3 academic centers. Multiplex preoperative patient imaging, endoscopic, and laboratory values were evaluated. Patients who had prior neoadjuvant chemotherapy were excluded from the analyses. Multivariable logistic regression analysis addressed the prediction of NOC disease (pT3/pT4 and/or pN+). Internal validation was conducted using 500 bootstrap resampling. A decision tree analysis identified a cut-off point predicting high-risk disease.

Results: A total of 528 patients were included in the analysis with a mean age of 70 years, over 80% Caucasian, 63% male, 49.4% high grade, and equal distribution of renal pelvis and ureteral UTUC. NOC-UTUC was found in 169 (32%) patients on final pathology with 125 (24%) pT3, 44 (8%) pT4/pN+, and 81 (48%) having tumors in the renal pelvis/calyces, 74 (44%) ureteral tumors, and 14 (8%) had tumors in both locations. Biopsy tumor grade (OR 5.14, p<0.01), tumor architecture (OR 3.66, p=0.01), Hgb (OR 0.81, p=0.02), and eGFR (OR 0.98, p=0.01) levels were independently associated with NOC disease. A preoperative nomogram incorporating these 4 variables achieved 78% accuracy in predicting NOC-UTUC. The cut-off point for predicting high-risk disease was ≥ 0.435.

Conclusion: The authors state to have established an accurate tool for the prediction of locally advanced NOC-UTUC. According to them, this preoperative nomogram can be used to improve optimal selection of patients for preoperative systemic chemotherapy, facilitate clinical trial enrollment, and determine the need for lymph node dissection during surgery.

Presented by: Firas Petros, MD Anderson, Texas, USA

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, @GoldbergHanan, at the 18th Annual Meeting of the Society of Urologic Oncology, November 29-December 1, 2017 – Washington, DC