Postoperative nomogram to predict cancer‐specific survival after radical nephroureterectomy in patients with localised and/or locally advanced upper tract urothelial carcinoma without metastasis

BJU International - Tập 114 Số 5 - Trang 733-740 - 2014
Thomas Seisen1, Pierre Colin2,3, Vincent Hupertan4, David Yates1, Évanguelos Xylinas5, L. Nison6, Olivier Cussenot1, Y. Neuzillet7, Karim Bensalah8, Giacomo Novara9, Francesco Montorsi10, Richard Zigeuner11, Mesut Remzi12, Shahrokh F. Shariat13, Morgan Rouprêt1
1Academic Department of Urology la Pitié‐Salpêtrière Hospital, and Institut Universitaire de Cancérologie, University Paris 6 and Assistance Publique Hôpitaux de Paris Paris France
2Department of Urology, Hôpital Privé de La Louvière, Générale de Santé, Lille, France
3Department of Urology, Seclin Hospital, Seclin, France
4Academic Department of Urology and Statistics of Bichat‐Claude Bernard Hospital Assistance Publique‐Hôpitaux de Paris University Paris VII René Diderot
5Academic Department of Urology of Cochin Hospital Assistance Publique‐Hôpitaux de Paris University Paris V Paris France
6Academic Department of Urology, CHRU Lille, Lille Nord de France University, Lille, France
7Academic Department of Urology, Academic Hospital of Foch, Suresnes, France
8Academic Department of Urology, CHU Pontchaillou, Rennes, France
9Ospedali Riuniti of Bergamo, Bergamo, GN, Italy
10Vita-Salute University, Milan, FM, Italy
11Medical University of Graz, Graz, Austria
12Medical University of Landeskrankenhaus Weinviertel-Korneuburg, Korneuburg, Austria
13Department of Urology, Medical University of Vienna, Vienna, Austria

Tóm tắt

ObjectiveTo propose and validate a nomogram to predict cancer‐specific survival (CSS) after radical nephroureterectomy (RNU) in patients with pT1–3/N0–x upper tract urothelial carcinoma (UTUC).Patients and MethodsThe international and the French national collaborative groups on UTUC pooled data from 3387 patients treated with RNU. Only 2233 chemotherapy naïve pT1–3/N0–x patients were included in the present study. The population was randomly split into the development cohort (1563) and the external validation cohort (670). To build the nomogram, logistic regressions were used for univariable and multivariable analyses. Different models were generated. The most accurate model was assessed using Harrell's concordance index and decision curve analysis (DCA). Internal validation was then performed by bootstrapping. Finally, the nomogram was calibrated and externally validated in the external dataset.ResultsOf the 1563 patients in the nomogram development cohort, 309 (19.7%) died during follow‐up from UTUC. The actuarial CSS probability at 5 years was 75.7% (95% confidence interval [CI] 73.2–78.6%). DCA revealed that the use of the best model was associated with benefit gains relative to prediction of CSS. The optimised nomogram included only six variables associated with CSS in multivariable analysis: age (P < 0.001), pT stage (P < 0.001), grade (P < 0.02), location (P < 0.001), architecture (P < 0.001) and lymphovascular invasion (P < 0.001). The accuracy of the nomogram was 0.81 (95% CI, 0.78–0.85). Limitations included the retrospective study design and the lack of a central pathological review.ConclusionAn accurate postoperative nomogram was developed to predict CSS after RNU only in locally and/or locally advanced UTUC without metastasis, where the decision for adjuvant treatment is controversial but crucial for the oncological outcome.

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BJU International

Tập 114 Số 5

733-740

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