Postoperative Nomogram for Relapse-Free Survival in Patients with High Grade Upper Tract Urothelial Carcinoma.
We developed a prognostic nomogram for patients with high grade urothelial carcinoma of the upper urinary tract after extirpative surgery.



Clinical data were available for 2,926 patients diagnosed with high grade urothelial carcinoma of the upper urinary tract who underwent extirpative surgery. Cox proportional hazard regression models identified independent prognosticators of relapse in the development cohort (838). A backward step-down selection process was applied to achieve the most informative nomogram with the least number of variables. The L2-regularized logistic regression was applied to generate the novel nomogram. Harrell's concordance indices were calculated to estimate the discriminative accuracy of the model. Internal validation processes were performed using bootstrapping, random sampling, tenfold cross-validation, LOOCV, Brier score, information score and F1 score. External validation was performed on an external cohort (2,088). Decision tree analysis was used to develop a risk classification model. Kaplan-Meier curves were applied to estimate the relapse rate for each category.



Overall 35.3% and 30.7% of patients experienced relapse in the development and external validation cohort. The final nomogram included age, pT stage, pN stage and architecture. It achieved a discriminative accuracy of 0.71 and 0.76, and the AUC was 0.78 and 0.77 in the development and external validation cohort, respectively. Rigorous testing showed constant results. The 5-year relapse-free survival rates were 88.6%, 68.1%, 40.2% and 12.5% for the patients with low risk, intermediate risk, high risk and very high risk disease, respectively.



The current nomogram, consisting of only 4 variables, shows high prognostic accuracy and risk stratification for patients with high grade urothelial carcinoma of the upper urinary tract following extirpative surgery, thereby adding meaningful information for clinical decision making.
Department of Urology, University of Muenster Medical Center, Muenster, Germany; Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
Laura-Maria
LM
Krabbe
Department of Urology, University Hospital of Cologne, Cologne, Germany; Department of Urology, Stanford University School of Medicine, Stanford, California.
Okyaz
O
Eminaga
Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
Shahrokh F
SF
Shariat
Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
Ryan C
RC
Hutchinson
Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
Yair
Y
Lotan
Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
Arthur I
AI
Sagalowsky
Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Jay D
JD
Raman
Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Christopher G
CG
Wood
Department of Urology, University of Michigan, Ann Arbor, Michigan.
Alon Z
AZ
Weizer
Department of Urology, AO Papa Giovanni XXIII, Bergamo, Italy.
Marco
M
Roscigno
Department of Urology, Vita Salute University, San Raffaele, Milan, Italy.
Francesco
F
Montorsi
Department of Urology, University of Ulm, Ulm, Germany.
Christian
C
Bolenz
Department of Surgery, Oncology and Gastroenterology - Urologic Clinic, University of Padua, Padua, Italy.
Giacomo
G
Novara
Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Eiji
E
Kikuchi
Department of Urology, General Hospital of St. Poelten, St. Poelten, Austria.
Harun
H
Fajkovic
Department of Uronephrology and Reproductive Health, Sechenov First Moscow State Medical University, Moscow, Russia.
Leonid M
LM
Rapoport
Department of Uronephrology and Reproductive Health, Sechenov First Moscow State Medical University, Moscow, Russia.
Peter V
PV
Glybochko
Department of Urology, Medical University of Graz, Graz, Austria.
Richard
R
Zigeuner
Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria.
Mesut
M
Remzi
Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France.
Karim
K
Bensalah
Department of Urology, McGill University Health Center, Montreal, Quebec, Canada.
Wassim
W
Kassouf
Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
Vitaly
V
Margulis
D002277:Carcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D003663:Decision Trees; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D049451:Nomograms; D011379:Prognosis; D012680:Sensitivity and Specificity; D014571:Urologic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D019459:Urothelium
carcinoma; nomograms; prognosis; recurrence; transitional cell