title: Postoperative nomogram for disease recurrence and cancer-specific death for upper tract urothelial carcinoma: comparison to American Joint Committee on Cancer staging classification.
abstract: OBJECTIVE
  We sought to develop prognostic models to predict disease recurrence and cancerspecific mortality in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU).
  
  
  METHODS
  Data on 253 patients treated with RNU between 1995 and 2008 at a single high-volume tertiary referral center were analyzed. Statistically and clinically significant patient and tumor characteristics were identified in a univariate analysis and incorporated into a multivariable Cox regression model. The model was compared to the 2010 American Joint Committee on Cancer (AJCC) staging classification using the concordance index (c-index), corrected for statistical optimism using bootstrap methods.
  
  
  RESULTS
  Five-year recurrence-free survival (RFS) and cancer-specific survival (CSS) rates were 73% [95% confidence interval (CI): 66-79%)] and 78% (95% CI: 71-84%), respectively. On multivariate analysis, higher preoperative glomerular filtration rate (GFR) was associated with better CSS [hazard ratio (HR) per 1 mL/min/m2 increase in GFR for CSS: 0.74; P = .002)], while higher pathologic stage (HR for pT2: 2.99 and for ≥ pT3: 7.34; P < .001) and lymph node involvement (HR: 3.75; P < .001) were associated with worse CSS; results were similar for RFS. The ability of the final models, which included preoperative GFR, lymph node status, pathologic grade, and stage, to predict RFS and CSS (c-index 0.82 and 0.83, respectively) was similar to that of the 2010 AJCC staging classification (c-index 0.80 and 0.81, respectively).
  
  
  CONCLUSIONS
  Given the data-dependent selection of variables in this single institution cohort, it is unlikely that the marginal improvement found with these prediction models would importantly impact clinical decision-making or improve patient care. The 2010 AJCC staging classification alone is very accurate and should continue to guide follow-up after RNU.
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. ehdaieb@mskcc.org.
authors.forename: Behfar
authors.initials: B
authors.lastname: Ehdaie
authors.affiliation: Department of Urology and Division of Medical Oncology, Weill Cornell Medical Center, New York-Presbyterian, New York, NY, USA.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Savage
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Coleman
authors.affiliation: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Guido
authors.initials: G
authors.lastname: Dalbagni
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D002423:Cause of Death; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D009392:Nephrectomy; D049451:Nomograms; D015996:Survival Rate; D013997:Time Factors; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*