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首页> 外文期刊>BJU international >Postoperative nomogram to predict cancer-specific survival after radical nephroureterectomy in patients with localised and/or locally advanced upper tract urothelial carcinoma without metastasis
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Postoperative nomogram to predict cancer-specific survival after radical nephroureterectomy in patients with localised and/or locally advanced upper tract urothelial carcinoma without metastasis

机译：术后诺模图可预测局部和/或局部晚期上尿路尿路上皮癌无转移的患者行根治性肾癌切除术后的癌症特异性存活率

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Objective To propose and validate a nomogram to predict cancer-specific survival (CSS) after radical nephroureterectomy (RNU) in patients with pT1-3/N0-x upper tract urothelial carcinoma (UTUC). Patients and Methods The international and the French national collaborative groups on UTUC pooled data from 3387 patients treated with RNU. Only 2233 chemotherapy na?ve pT1-3/N0-x patients were included in the present study. The population was randomly split into the development cohort (1563) and the external validation cohort (670). To build the nomogram, logistic regressions were used for univariable and multivariable analyses. Different models were generated. The most accurate model was assessed using Harrell's concordance index and decision curve analysis (DCA). Internal validation was then performed by bootstrapping. Finally, the nomogram was calibrated and externally validated in the external dataset. Results Of the 1563 patients in the nomogram development cohort, 309 (19.7%) died during follow-up from UTUC. The actuarial CSS probability at 5 years was 75.7% (95% confidence interval [CI] 73.2-78.6%). DCA revealed that the use of the best model was associated with benefit gains relative to prediction of CSS. The optimised nomogram included only six variables associated with CSS in multivariable analysis: age (P < 0.001), pT stage (P < 0.001), grade (P < 0.02), location (P < 0.001), architecture (P < 0.001) and lymphovascular invasion (P < 0.001). The accuracy of the nomogram was 0.81 (95% CI, 0.78-0.85). Limitations included the retrospective study design and the lack of a central pathological review. Conclusion An accurate postoperative nomogram was developed to predict CSS after RNU only in locally and/or locally advanced UTUC without metastasis, where the decision for adjuvant treatment is controversial but crucial for the oncological outcome.
机译：目的提出并验证诺曼图，以预测pT1-3 / N0-x上尿路尿路上皮癌（UTUC）患者行根治性肾切除术（RNU）后的癌症特异性生存率（CSS）。患者和方法国际和法国国家UTUC合作小组汇总了3387例接受RNU治疗的患者的数据。本研究仅包括2233例单纯的pT1-3 / N0-x患者。总体随机分为发展队列（1563）和外部验证队列（670）。为了构建列线图，将逻辑回归用于单变量和多变量分析。生成了不同的模型。使用Harrell的一致性指数和决策曲线分析（DCA）评估了最准确的模型。然后通过自举执行内部验证。最后，在外部数据集中对列线图进行了校准和外部验证。结果诺模图发展队列中的1563例患者中，有309例（19.7％）在UTUC随访期间死亡。 5年的CSS精算概率为75.7％（95％置信区间[CI] 73.2-78.6％）。 DCA揭示，相对于CSS预测，最佳模型的使用与收益相关。在多变量分析中，优化的列线图仅包含与CSS相关的六个变量：年龄（P <0.001），pT阶段（P <0.001），等级（P <0.02），位置（P <0.001），建筑（P <0.001）和淋巴管浸润（P <0.001）。列线图的准确性为0.81（95％CI，0.78-0.85）。局限性包括回顾性研究设计和缺乏中央病理学检查。结论仅在局部和/或局部晚期UTUC中无转移的情况下，开发了准确的术后列线图以预测RNU后的CSS，辅助治疗的决定是有争议的，但对肿瘤的治疗结果至关重要。

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