Preoperative predictive model and nomogram for disease recurrence following radical nephroureterectomy for high grade upper tract urothelial carcinoma.

To identify preoperative risk factors for disease recurrence, following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), and to create a predictive nomogram.

Based on a multicenter database, we identified patients who underwent RNU due to high grade UTUC. Urothelial carcinoma of the bladder or contralateral UTUC was not considered as recurrence. Cox regression model was used to determine the effect of different preoperative variables as predictors of recurrence.

Two hundred and forty-five patients were included in the analysis. The 2 and 5 years recurrence rates were 16.3% and 19.2%, respectively. Factors associated with recurrence on univariable analysis were sessile architecture hazard ratio (HR) 3.16 (95% CI, 1.38-7.26, P = 0.006), ≥cT3 disease HR 2.30 (95% CI, 1.12-4.72, P= 0.023), age >65 HR 2.02 (95% CI, 1.00-4.05, P= 0.048), Eastern Cooperative Group > 0 HR 1.98 (95% CI, 1.09-3.57, P= 0.023), hydronephrosis HR 1.93 (95% CI, 1.04-3.57, P= 0.035). Higher hemoglobin levels HR 0.81 (95% CI, 0.69-0.96, P= 0.013) and preoperative estimated glomerular filtration rate ≥ 50 HR 0.48 (95% CI, 0.25-0.92, P= 0.028) were associated with lower probability for recurrence. Multivariable analysis identified sessile architecture as the only independent predictor of recurrence HR 2.52 (95% CI, 1.09-5.86, P= 0.0308). C-index of 0.71 was calculated for a predictive model including all variables in the multivariable analysis, indicating good predictive accuracy. A nomogram predicting 2 and 5 year recurrence free probability was developed accordingly.

Based on a multicenter database, we developed a nomogram with good predictive accuracy for recurrence following RNU. This may serve as an aid in decision-making regarding the use of neoadjuvant chemotherapy.

Urologic oncology. 2019 Aug 01 [Epub ahead of print]

Yuval Freifeld, Rashed Ghandour, Nirmish Singla, Solomon Woldu, Timothy Clinton, Rohan Kulangara, Aditya Bagrodia, Surena F Matin, Firas G Petros, Jay D Raman, Haley Robyak, Jingsheng Yan, Hong Zhu, Leonid Rapoport, Yair Lotan, Vitaly Margulis

Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX., University of Texas Southwestern, Medical School, Dallas, TX., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX., Division of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA., Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX., Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX; Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX., Research Institute of Uronephrology and Human Reproductive Health, I.M Sechenov First Moscow State Medical University, Moscow, Russia., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: .

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