title: Nomogram predicting renal insufficiency after nephroureterectomy for upper tract urothelial carcinoma in the Chinese population: exclusion of ineligible candidates for adjuvant chemotherapy.
abstract: OBJECTIVE
  To report the decline of renal function after radical nephroureterectomy (RNU) in upper tract urothelial carcinoma (UTUC) patients and to develop a nomogram to predict ineligibility for cisplatin-based adjuvant chemotherapy (AC).
  
  
  METHODS
  We retrospectively analyzed 606 consecutive Chinese UTUC patients treated by RNU from 2000 to 2010. We chose an eGFR of 60 and 45 ml/min/1.73 m(2) as cut-offs for full-dose and reduced-dose AC eligibility.
  
  
  RESULTS
  Median eGFR for all patients before and after surgery was 64 and 49 ml/min/1.73 m(2) (P < 0.001). The proportion of patients ineligible to receive full-dose and reduced-dose AC changed from 42% to 74% and from 20% to 38.1%. Older age (OR = 1.007), preoperative eGFR (OR = 0.993), absence of hydronephrosis (OR = 0.801), smaller tumor size (OR = 0.962), and tumor without multifocality (OR = 0.876) were predictive for ineligibility for full-dose AC. Preoperative eGFR (OR = 0.991), absence of hydronephrosis (OR = 0.881), tumor located in renal pelvis (OR = 1.164), and smaller tumor size (OR = 0.969) could predict ineligibility for reduced-dose AC. The c-index of the two models was 0.757 and 0.836. Postoperative renal function was not associated with worse survival.
  
  
  CONCLUSIONS
  Older age, lower preoperative eGFR, smaller tumor size, tumor located in renal pelvis, and absence of hydronephrosis or multifocality were predictors of postoperative renal insufficiency.
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Fang
authors.affiliation: Department of Urology, Jilin Tumour Hospital, No. 1018 Huguang Road, Chaoyang District, Changchun, Jilin 130021, China.
authors.forename: Qifu
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
authors.forename: Xuesong
authors.identifier: 0000-0002-7030-0856
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Qian
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
authors.forename: Gengyan
authors.initials: G
authors.lastname: Xiong
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China ; Department of Urology, Tangdu Hospital, Fourth Military Medical University, No.1 Xinsi Road, Baqiao District, Xi'an, Shaanxi 710038, China.
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
authors.forename: Zhisong
authors.initials: Z
authors.lastname: He
authors.affiliation: Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Centre, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.
authors.forename: Liqun
authors.initials: L
authors.lastname: Zhou
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000706:statistics & numerical data*; D049451:Nomograms; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D051437:Renal Insufficiency / Q000453:epidemiology*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin