title: Prediction of cancer specific survival after radical nephroureterectomy for upper tract urothelial carcinoma: development of an optimized postoperative nomogram using decision curve analysis.
abstract: OBJECTIVE
  We conceived and proposed a unique and optimized nomogram to predict cancer specific survival after radical nephroureterectomy in patients with upper tract urothelial carcinoma by merging the 2 largest multicenter data sets reported in this population.
  
  
  METHODS
  The international and the French national collaborative groups on upper tract urothelial carcinoma pooled data on 3,387 patients treated with radical nephroureterectomy for whom full data for nomogram development were available. The merged study population was randomly split into the development cohort (2,371) and the external validation cohort (1,016). Cox regressions were used for univariable and multivariable analyses, and to build different models. The ultimate reduced nomogram was assessed using Harrell's concordance index (c-index) and decision curve analysis.
  
  
  RESULTS
  Of the 2,371 patients in the nomogram development cohort 510 (21.5%) died of upper tract urothelial carcinoma during followup. The actuarial cancer specific survival probability at 5 years was 73.7% (95% CI 71.9-75.6). Decision curve analysis revealed that the use of the best model was associated with benefit gains relative to the prediction of cancer specific survival. The optimized nomogram included only 5 variables associated with cancer specific survival on multivariable analysis, those of age (p = 0.001), T stage (p <0.001), N stage (p = 0.001), architecture (p = 0.02) and lymphovascular invasion (p = 0.001). The discriminative accuracy of the nomogram was 0.8 (95% CI 0.77-0.86).
  
  
  CONCLUSIONS
  Using standard pathological features obtained from the largest data set of upper tract urothelial carcinomas worldwide, we devised and validated an accurate and ultimate nomogram, superior to any single clinical variable, for predicting cancer specific survival after radical nephroureterectomy.
authors.affiliation: Academic Department of Urology and Division of Medical Oncology, Weill Cornell Medical College, New York Presbyterian-Hospital, New York, New York, USA. morgan.roupret@psl.aphp.fr
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Vincent
authors.initials: V
authors.lastname: Hupertan
authors.forename: Thomas
authors.initials: T
authors.lastname: Seisen
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: David R
authors.initials: DR
authors.lastname: Yates
authors.forename: Harun
authors.initials: H
authors.lastname: Fajkovic
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: François
authors.initials: F
authors.lastname: Rozet
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.forename: Juan I
authors.initials: JI
authors.lastname: Martinez-Salamanca
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walton
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality* / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D049451:Nomograms; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000401:mortality* / Q000601:surgery*