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

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

Research output: Contribution to journalArticle

Abstract

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

Original languageEnglish (US)
Pages (from-to)758-764
Number of pages7
JournalUrologic Oncology: Seminars and Original Investigations
Volume37
Issue number10
DOIs
StatePublished - Oct 1 2019

Fingerprint

Nomograms
Carcinoma
Recurrence
Databases
Hydronephrosis
Glomerular Filtration Rate
Proportional Hazards Models
Decision Making
Hemoglobins
Urinary Bladder
Drug Therapy

Keywords

  • Metastasis
  • Nephroureterectomy
  • Nomogram
  • Recurrence
  • Upper tract urothelial carcinoma
  • UTUC

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Preoperative predictive model and nomogram for disease recurrence following radical nephroureterectomy for high grade upper tract urothelial carcinoma. / Freifeld, Yuval; Ghandour, Rashed; Singla, Nirmish; Woldu, Solomon; Clinton, Timothy; Kulangara, Rohan; Bagrodia, Aditya; Matin, Surena F.; Petros, Firas G.; Raman, Jay D.; Robyak, Haley; Yan, Jingsheng; Zhu, Hong; Rapoport, Leonid; Lotan, Yair; Margulis, Vitaly.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 37, No. 10, 01.10.2019, p. 758-764.

Research output: Contribution to journalArticle

Freifeld, Yuval ; Ghandour, Rashed ; Singla, Nirmish ; Woldu, Solomon ; Clinton, Timothy ; Kulangara, Rohan ; Bagrodia, Aditya ; Matin, Surena F. ; Petros, Firas G. ; Raman, Jay D. ; Robyak, Haley ; Yan, Jingsheng ; Zhu, Hong ; Rapoport, Leonid ; Lotan, Yair ; Margulis, Vitaly. / Preoperative predictive model and nomogram for disease recurrence following radical nephroureterectomy for high grade upper tract urothelial carcinoma. In: Urologic Oncology: Seminars and Original Investigations. 2019 ; Vol. 37, No. 10. pp. 758-764.
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abstract = "Purpose: To identify preoperative risk factors for disease recurrence, following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), and to create a predictive nomogram. Materials and methods: 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. Results: 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. Conclusions: 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.",
keywords = "Metastasis, Nephroureterectomy, Nomogram, Recurrence, Upper tract urothelial carcinoma, UTUC",
author = "Yuval Freifeld and Rashed Ghandour and Nirmish Singla and Solomon Woldu and Timothy Clinton and Rohan Kulangara and Aditya Bagrodia and Matin, {Surena F.} and Petros, {Firas G.} and Raman, {Jay D.} and Haley Robyak and Jingsheng Yan and Hong Zhu and Leonid Rapoport and Yair Lotan and Vitaly Margulis",
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T1 - Preoperative predictive model and nomogram for disease recurrence following radical nephroureterectomy for high grade upper tract urothelial carcinoma

AU - Freifeld, Yuval

AU - Ghandour, Rashed

AU - Singla, Nirmish

AU - Woldu, Solomon

AU - Clinton, Timothy

AU - Kulangara, Rohan

AU - Bagrodia, Aditya

AU - Matin, Surena F.

AU - Petros, Firas G.

AU - Raman, Jay D.

AU - Robyak, Haley

AU - Yan, Jingsheng

AU - Zhu, Hong

AU - Rapoport, Leonid

AU - Lotan, Yair

AU - Margulis, Vitaly

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Purpose: To identify preoperative risk factors for disease recurrence, following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), and to create a predictive nomogram. Materials and methods: 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. Results: 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. Conclusions: 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.

AB - Purpose: To identify preoperative risk factors for disease recurrence, following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), and to create a predictive nomogram. Materials and methods: 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. Results: 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. Conclusions: 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.

KW - Metastasis

KW - Nephroureterectomy

KW - Nomogram

KW - Recurrence

KW - Upper tract urothelial carcinoma

KW - UTUC

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