title: Cancer-specific survival after radical nephroureterectomy for upper urinary tract urothelial carcinoma: proposal and multi-institutional validation of a post-operative nomogram.
abstract: BACKGROUND
  Owing to the scarcity of upper urinary tract urothelial carcinoma (UUT-UC) it is often necessary for investigators to pool data. A patient-specific survival nomogram based on such data is needed to predict cancer-specific survival (CSS) post nephroureterectomy (NU). Herein, we propose and validate a nomogram to predict CSS post NU.
  
  
  METHODS
  Twenty-one French institutions contributed data on 1120 patients treated with NU for UUT-UC. A total of 667 had full data for nomogram development. Study population was divided into the nomogram development cohort (397) and external validation cohort (270). Cox proportional hazards regression models were used for univariate and multivariate analyses and to build a nomogram. A reduced model selection was performed using a backward step-down selection process, and Harrell's concordance index (c-index) was used for quantifying the nomogram accuracy. Internal validation was performed by bootstrapping and the reduced nomogram model was calibrated.
  
  
  RESULTS
  Of the 397 patients in the nomogram development cohort, 91 (22.9%) died during follow-up, of which 66 (72.5%) died as a consequence of UUT-UC. The actuarial CSS probability at 5 years was 0.76 (95% CI, 71.62-80.94). On multivariate analysis, T stage (P<0.0001), N status (P=0.014), grade (P=0.026), age (P=0.005) and location (P=0.022) were associated with CSS. The reduced nomogram model had an accuracy of 0.78. We propose a nomogram to predict 3 and 5-year CSS post NU for UUT-UC.
  
  
  CONCLUSIONS
  We have devised and validated an accurate nomogram (78%), superior to any single clinical variable or current model, for predicting 5-year CSS post NU for UUT-UC.
authors.affiliation: Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, 47-83 Boulevard de l'Hopital, Paris 75013, France.
authors.forename: D R
authors.initials: DR
authors.lastname: Yates
authors.forename: V
authors.initials: V
authors.lastname: Hupertan
authors.forename: P
authors.initials: P
authors.lastname: Colin
authors.forename: A
authors.initials: A
authors.lastname: Ouzzane
authors.forename: A
authors.initials: A
authors.lastname: Descazeaud
authors.forename: J A
authors.initials: JA
authors.lastname: Long
authors.forename: G
authors.initials: G
authors.lastname: Pignot
authors.forename: S
authors.initials: S
authors.lastname: Crouzet
authors.forename: F
authors.initials: F
authors.lastname: Rozet
authors.forename: Y
authors.initials: Y
authors.lastname: Neuzillet
authors.forename: M
authors.initials: M
authors.lastname: Soulie
authors.forename: T
authors.initials: T
authors.lastname: Bodin
authors.forename: A
authors.initials: A
authors.lastname: Valeri
authors.forename: O
authors.initials: O
authors.lastname: Cussenot
authors.forename: M
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002138:Calibration; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009392:Nephrectomy; D049451:Nomograms; D011379:Prognosis; D016016:Proportional Hazards Models; D014513:Ureter / Q000473:pathology / Q000601:surgery*; D014571:Urologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*