Development and Validation of a Model for Predicting Intravesical Recurrence in Organ-confined Upper Urinary Tract Urothelial Carcinoma Patients after Radical Nephroureterectomy: a Retrospective Study in One Center with Long-term Follow-up

Although radical nephroureterectomy is the standard treatment method for upper urinary tract urothelial carcinoma, it is associated with a high risk of intravesical recurrence. There are no models for predicting IVR after RNU in patients with organ-confined UTUC. Therefore, we developed and validate...

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Veröffentlicht in:Pathology oncology research 2020-07, Vol.26 (3), p.1741-1748
Hauptverfasser: Zhang, Xuanyu, Bu, Renge, Liu, Zeqi, Wu, Bin, Bai, Song
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Bu, Renge
Liu, Zeqi
Wu, Bin
Bai, Song
description Although radical nephroureterectomy is the standard treatment method for upper urinary tract urothelial carcinoma, it is associated with a high risk of intravesical recurrence. There are no models for predicting IVR after RNU in patients with organ-confined UTUC. Therefore, we developed and validated a model for postoperative prediction of IVR after RNU. The development cohort consisted of 416 patients who underwent RNU with bladder cuff excision at our center between 1 January 2007 and 31 December 2015. Patient clinicopathologic data were recorded. Multivariate Cox proportional hazard ratio regression was used to build a predictive model with regression coefficients, backward step-wise selection was applied, and the likelihood ratio test with Akaike’s information criterion was used as the stopping rule. An independent cohort consisting of 152 consecutive patients from 1 January 2016 and 31 December 2017 was used for validation. The performance of this predictive model was assessed with respect to discrimination, calibration, and clinical usefulness. The predictors in this model included tumor stage, tumor diameter, tumor location, and tumor grade. In the validation cohort, the model showed good discrimination, with a concordance index of 0.689 (95% CI, 0.629 to 0.748) and good calibration. Decision curve analysis demonstrated that the model was also clinically useful. This study presents a good model that may facilitate individualized postoperative prediction of IVR after RNU in patients with organ-confined UTUC, and thus, may help improve postoperative strategies and facilitate treatment outcomes.
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subjects Biomedical and Life Sciences
Biomedicine
Bladder cancer
Cancer Research
Carcinoma, Transitional Cell - pathology
Carcinoma, Transitional Cell - surgery
Humans
Immunology
Neoplasm Recurrence, Local - epidemiology
Nephroureterectomy - methods
Oncology
Original Article
Pathology
Patients
Prediction models
Retrospective Studies
Urinary tract
Urogenital system
Urologic Neoplasms - pathology
Urologic Neoplasms - surgery
Urothelial carcinoma
title Development and Validation of a Model for Predicting Intravesical Recurrence in Organ-confined Upper Urinary Tract Urothelial Carcinoma Patients after Radical Nephroureterectomy: a Retrospective Study in One Center with Long-term Follow-up
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