Prediction of Cancer Specific Survival After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: Development of an Optimized Postoperative Nomogram Using Decision Curve Analysis

被引：145

作者：

Roupret, Morgan ^{[1
,2
,3
]}

Hupertan, Vincent ^{[5
]}

Seisen, Thomas ^{[3
]}

Colin, Pierre ^{[8
]}

Xylinas, Evanguelos ^{[1
,2
,6
]}

Yates, David R. ^{[3
]}

Fajkovic, Harun ^{[10
]}

Lotan, Yair ^{[13
]}

Raman, Jay D. ^{[15
]}

Zigeuner, Richard ^{[11
]}

Remzi, Mesut ^{[12
]}

Bolenz, Christian ^{[16
]}

Novara, Giacomo ^{[18
]}

Kassouf, Wassim ^{[20
]}

Ouzzane, Adil ^{[8
]}

Rozet, Francois ^{[7
]}

Cussenot, Olivier ^{[4
]}

Martinez-Salamanca, Juan I. ^{[22
]}

Fritsche, Hans-Martin ^{[17
]}

Walton, Thomas J. ^{[23
]}

Wood, Christopher G. ^{[14
]}

Bensalah, Karim ^{[9
]}

Karakiewicz, Pierre I. ^{[21
]}

Montorsi, Francesco ^{[19
]}

Margulis, Vitaly ^{[13
]}

Shariat, Shahrokh F. ^{[1
,2
]}

机构：

[1] New York Presbyterian Hosp, Weill Cornell Med Coll, Dept Urol, New York, NY USA

[2] New York Presbyterian Hosp, Weill Cornell Med Coll, Div Med Oncol, New York, NY USA

[3] Hop La Pitie Salpetriere, Acad Urol Dept, F-75013 Paris, France

[4] Univ Paris 06, Fac Med Pierre & Marie Curie, Acad Dept Urol, Tenon Hosp,AP HP, Paris, France

[5] Univ Paris 07, Bichat Claude Bernard Hosp, AP HP, Acad Dept Urol & Stat, Paris, France

[6] Univ Paris 05, Cochin Hosp, AP HP, Acad Dept Urol, Paris, France

[7] Inst Mutualiste Montsouris, Dept Urol, Paris, France

[8] Univ Lille Nord France, CHRU Lille, Acad Dept Urol, Lille, France

[9] CHU Pontchaillou, Acad Dept Urol, Rennes, France

[10] Gen Hosp St Poelten, St Polten, Austria

[11] Med Univ Graz, Graz, Austria

[12] Landeskrankenhaus Weinviertel Korneuburg, Korneuburg, Austria

[13] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA

[14] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA

[15] Penn State Milton S Hershey Med Ctr, Hershey, PA USA

[16] Heidelberg Univ, Mannheim Med Ctr, Mannheim, Germany

[17] Univ Regensburg, Caritas St Josef Med Ctr, D-93053 Regensburg, Germany

[18] Osped Riuniti Bergamo, I-24100 Bergamo, Italy

[19] Univ Vita Salute San Raffaele, Milan, Italy

[20] McGill Univ, Ctr Hlth, Montreal, PQ, Canada

[21] Univ Montreal, Montreal, PQ, Canada

[22] Univ Autonoma Madrid, Hosp Univ Puerta de Hierro Majadahonda, Madrid, Spain

[23] City Hosp Nottingham, Nottingham, England

来源：

JOURNAL OF UROLOGY | 2013年 / 189卷 / 05期

关键词：

ureter; kidney pelvis; carcinoma; transitional cell; survival; nomograms; PREOPERATIVE NOMOGRAM; PROGNOSTIC MODELS; OUTCOMES; VALIDATION; RECURRENCE;

D O I：

10.1016/j.juro.2012.10.057

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Purpose: 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. Materials and 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.

引用

页码：1662 / 1669

页数：8

共 31 条

[1] Assessment of Oncologic Control Obtained After Open Versus Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinomas (UUT-UCs): Results from a Large French Multicenter Collaborative Study [J].

Ariane, Mehdi Mokhtar ;

Colin, Pierre ;

Ouzzane, Adil ;

Pignot, Geraldine ;

Audouin, Marie ;

Cornu, Jean-Nicolas ;

Albouy, Baptiste ;

Guillotreau, Julien ;

Neuzillet, Yann ;

Crouzet, Sebastien ;

Hurel, Sophie ;

Arroua, Frederic ;

Bigot, Pierre ;

Marchand, Charles ;

Fais, Pierre Olivier ;

de la Taille, Alexandre ;

Saint, Fabien ;

Ravier, Emmanuel ;

Matte, Alexandre ;

Guy, Laurent ;

Bruyere, Franck ;

Roupret, Morgan .

ANNALS OF SURGICAL ONCOLOGY, 2012, 19 (01) :301-308

[2] Predicting Clinical Outcomes After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma [J].

Cha, Eugene K. ;

Shariat, Shahrokh F. ;

Kormaksson, Matthias ;

Novara, Giacomo ;

Chromecki, Thomas F. ;

Scherr, Douglas S. ;

Lotan, Yair ;

Raman, Jay D. ;

Kassouf, Wassim ;

Zigeuner, Richard ;

Remzi, Mesut ;

Bensalah, Karim ;

Weizer, Alon ;

Kikuchi, Eiji ;

Bolenz, Christian ;

Roscigno, Marco ;

Koppie, Theresa M. ;

Ng, Casey K. ;

Fritsche, Hans-Martin ;

Matsumoto, Kazumasa ;

Walton, Thomas J. ;

Ehdaie, Behfar ;

Tritschler, Stefan ;

Fajkovic, Harun ;

Martinez-Salamanca, Juan I. ;

Pycha, Armin ;

Langner, Cord ;

Ficarra, Vincenzo ;

Patard, Jean-Jacques ;

Montorsi, Francesco ;

Wood, Christopher G. ;

Karakiewicz, Pierre I. ;

Margulis, Vitaly .

EUROPEAN UROLOGY, 2012, 61 (04) :818-825

[3] The Impact of Tumor Multifocality on Outcomes in Patients Treated With Radical Nephroureterectomy [J].

Chromecki, Thomas F. ;

Cha, Eugene K. ;

Fajkovic, Harun ;

Margulis, Vitaly ;

Novara, Giacomo ;

Scherr, Douglas S. ;

Lotan, Yair ;

Raman, Jay D. ;

Kassouf, Wassim ;

Bensalah, Karim ;

Weizer, Alon ;

Kikuchi, Eiji ;

Roscigno, Marco ;

Remzi, Mesut ;

Matsumoto, Kazumasa ;

Walton, Thomas J. ;

Pycha, Armin ;

Ficarra, Vincenzo ;

Karakiewicz, Pierre I. ;

Zigeuner, Richard ;

Pummer, Karl ;

Shariat, Shahrokh F. .

EUROPEAN UROLOGY, 2012, 61 (02) :245-253

[4]

Efron B, 1993, INTRO BOOTSTRAP, P275

[5] The World Health Organization International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder [J].

Epstein, JI ;

Amin, MB ;

Reuter, VR ;

Mostofi, FK .

AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 1998, 22 (12) :1435-1448

[6]

Greene F., 2002, AJCC cancer staging handbook: From the AJCC cancer staging manual, V6th

[7]

Harrell FE, 1996, STAT MED, V15, P361, DOI 10.1002/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO

[8]

2-4

[9]

Harrell FrankE., 2009, Design: Design Package

[10] Predictive power to assist phase 3 go/no go decision based on phase 2 data on a different endpoint [J].

Hong, Shengyan ;

Shi, Li .

STATISTICS IN MEDICINE, 2012, 31 (09) :831-843

← 1 2 3 4 →