title: Preoperative multivariable prognostic model for prediction of nonorgan confined urothelial carcinoma of the upper urinary tract.
abstract: OBJECTIVE
  We created a prognostic tool for the accurate preoperative prediction of nonorgan confined upper tract urothelial carcinoma.
  
  
  METHODS
  A computerized data bank containing comprehensive information on 1,453 patients who underwent radical nephroureterectomy at 13 academic institutions was generated and continuously updated. This study comprised a subset of 659 patients in whom all appropriate preoperative prognostic variables (age, gender, race, symptoms, Eastern Cooperative Oncology Group performance status, primary tumor location, tumor architecture, tumor grade and history of previous bladder cancer) were available for statistical analysis. A multivariable logistic regression model containing relevant clinicopathological variables addressed the prediction of nonorgan confined stage disease (T3-4 and/or N+) at radical nephroureterectomy. A backward step-down selection process was applied to achieve the most informative and parsimonious model. Internal validation was performed using 200 bootstrap resamples.
  
  
  RESULTS
  Pathological nonorgan confined urothelial carcinoma was found in 40% of patients. Grade, architecture and location of the tumor were independently associated with nonorgan confined disease. A nomogram including these 3 variables achieved 76.6% accuracy in predicting nonorgan confined upper tract urothelial cancer.
  
  
  CONCLUSIONS
  We developed a simple and accurate prognostic tool for the prediction of locally advanced upper tract urothelial cancer. This preoperative prediction model can be used for designing clinical trials, selecting patients for preoperative systemic therapy and guiding the extent of concomitant lymph node dissection at nephroureterectomy.
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, Texas 75390-9110, USA. vmargu@hotmail.com
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Youssef
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Alon
authors.initials: A
authors.lastname: Weizer
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D014516:Ureteral Neoplasms / Q000473:pathology*