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Hensley PJ, Labbate C, Zganjar A, Howard J, Huelster H, Durdin T, Pham J, Xiao L, Pallauf M, Lombardo K, Glezerman I, Singla N, Raman JD, Coleman J, Spiess PE, Margulis V, Potretzke AM, Matin SF. Development and Validation of a Multivariable Nomogram Predictive of Post-Nephroureterectomy Renal Function. Eur Urol Oncol 2024:S2588-9311(24)00030-0. [PMID: 38307832 DOI: 10.1016/j.euo.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/08/2023] [Accepted: 01/04/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND AND OBJECTIVE The timing of perioperative nephrotoxic chemotherapy for upper tract urothelial carcinoma (UTUC) remains controversial and strongly depends on predicted platinum eligibility after radical nephroureterectomy (RNU). The study objective was to develop and validate a multivariable nomogram to predict estimated glomerular filtration rate (eGFR) following RNU. METHODS This was a multi-institutional retrospective study of patients with UTUC treated with RNU from 2000 to 2020 at seven high-volume referral centers. Use of adjuvant chemotherapy was risk-stratified. Patients were retrospectively randomly allocated 2:1 to discovery and validation cohorts. Discovery data were used to identify independent factors associated with GFR at 1-3 mo after RNU on linear regression, and backward selection was applied for model construction. Accuracy was defined as the percentage of predicted eGFR results within 30% of the corresponding observed eGFR. KEY FINDINGS AND LIMITATIONS We included 1100 patients, of whom 733 were in the discovery and 367 were in the validation cohort. Multivariable predictors of postoperative eGFR decline included advanced age (odds ratio [OR] -0.18, 95% confidence interval [CI] -0.28 to -0.08), diabetes (OR -2.38, 95% CI -4.64 to -0.11), and hypertension (OR -2.24, 95% CI -4.16 to -0.32). Factors associated with favorable postoperative eGFR included larger tumor size (OR 10.57, 95% CI 7.4-13.74 for tumors >5 cm vs ≤2 cm) and preoperative eGFR (OR 0.44, 95% CI 0.39-0.49). A composite nomogram predicted postoperative eGFR with good accuracy in both the discovery (80.5%) and validation (78.6%) cohorts. Limitations include exclusion of patients who received neoadjuvant chemotherapy. CONCLUSIONS A nomogram that incorporates ubiquitous preoperative clinical variables can predict post-RNU eGFR and was validated with an independent cohort. PATIENT SUMMARY We developed a tool that uses patient data to predict eligibility for chemotherapy after surgery to remove the kidney and ureter in patients with cancer in the upper urinary tract.
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Affiliation(s)
- Patrick J Hensley
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Craig Labbate
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeffrey Howard
- Department of Urology, The University of Texas Southwestern, Dallas, TX, USA
| | - Heather Huelster
- Department of Urology, Moffitt Cancer Center, Tampa, FL, USA; Department of Urology, Indiana University Health, Indianapolis, IN, USA
| | - Trey Durdin
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan Pham
- Department of Urology, Penn State Health, Hershey, PA, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maximilian Pallauf
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA; Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Kara Lombardo
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Ilya Glezerman
- Department of Nephrology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nirmish Singla
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Jay D Raman
- Department of Urology, Penn State Health, Hershey, PA, USA
| | - Jonathan Coleman
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Vitaly Margulis
- Department of Urology, The University of Texas Southwestern, Dallas, TX, USA
| | | | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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