Recent clinical trials have highlighted the benefits of adjuvant therapies for upper tract urothelial carcinoma (UTUC), although their application remains limited by patient-specific factors. This study aimed to develop a prognostic model to predict postoperative outcomes and identify patients who would benefit from adjuvant therapy.
We conducted a retrospective analysis of 700 UTUC patients who underwent radical nephroureterectomy at Jikei University Hospital and its affiliated institutions (development cohort), and 405 patients treated at Mayo Clinic (validation cohort). Patients who received neoadjuvant or adjuvant chemotherapy were excluded. In the development cohort, clinical and pathological variables were analyzed to construct a risk prediction model for postoperative recurrence. Statistical analyses included Kaplan-Meier estimation, Cox proportional hazards regression, and internal validation using bootstrapping. The model was externally validated using data from the validation cohort.
The final model incorporated pT stage, pN stage, tumor grade, and lymphovascular invasion, resulting in the novel "JIKEI-YAYOI" risk score (range: 0-7). The model demonstrated excellent discrimination (C-index: 0.815) and calibration. Patients were stratified into low, intermediate, and high-risk groups, each with distinct recurrence-free survival rates. The JIKEI-YAYOI score provided accurate, individualized risk predictions, facilitating clinical decision-making regarding adjuvant therapy.
The JIKEI-YAYOI score reliably predicts disease recurrence following radical surgery for UTUC, supporting personalized patient management and informed decisions about adjuvant therapy.
Urologic oncology. 2025 Oct 07 [Epub ahead of print]
Yuya Iwamoto, Halle Foss, Yudai Ishiyama, Yuki Taneda, Hirokazu Kagawa, Naoki Uchida, Yuhei Koike, Shuhei Hara, Keiichiro Miyajima, Kosuke Iwatani, Yu Imai, Kojiro Tashiro, Shunsuke Tsuzuki, Jun Miki, Sounak Gupta, Stephen A Boorjian, Aaron Potretzke, Fumihiko Urabe, Takahiro Kimura
Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Mayo Clinic, Rochester, MN., Department of Urology, Tokyo Women Medical University, Tokyo, Japan; Department of Urology, University of Florida Jacksonville, Jacksonville, FL., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Atsugi City Hospital, Kanagawa, Japan., Department of Pathology, Mayo Clinic, Rochester, MN., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei The 3rd Hospital, Tokyo, Japan. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41062404