Development and validation of a prognostic nomogram for patients with intravesical recurrence after radical nephroureterectomy for non-metastatic upper tract urothelial carcinoma
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To develop and validate a prognostic nomogram for patients with intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for non-metastatic upper tract urothelial carcinoma (UTUC).
The clinical data of 468 patients registered in the surveillance, epidemiology and end results database between 2010 and 2015 were retrospectively analyzed. Multivariate analysis using the Cox proportional hazard model was used to determine independent prognostic factors for the development of a nomogram to predict the 1-, 3-, and 5-year probability of individual cancer-specific survival (CSS). Moreover, the nomogram was internally validated using receiver operating characteristic curves and calibration plots.
Age at IVR > 80 years, UTUC stage ≥ T3, bladder cancer (BC) stage T1, and muscle-invasive BC (stage ≥ T2) were identified as independent risk factors for CSS in patients with IVR after RNU, whereas a time interval of > 24 months between UTUC and BC was an independent protective factor. The 1-, 3-, and 5-year predictive accuracies of our nomogram were 0.74, 0.70, and 0.71, respectively. Additionally, 1-, 3-, and 5-year calibration curves demonstrated perfect agreement between the nomogram-predicted and the actual CSS.
This study developed and internally validated the first nomogram to date to predict individual prognosis in patients with IVR after RUN for UTUC. This nomogram can be used for patient counseling and for designing clinical trials.
KeywordsUpper tract urothelial carcinoma Intravesical recurrence Prognosis Nomogram
This study was supported by the Natural Science Foundation Program of Shaanxi Province (Grant number: 2014JM4184) and the Natural Science Foundation Program of Shaanxi Province (Grant number: 2017JM8128).
Conception and design: YZ, JLY and FLW. Data acquisition: GDH. Data analysis and interpretation: LZ and FY. Manuscript drafting: GDH and XAL. Critical revision of the manuscript: JLY, GZ, PM, and DW. Statistical analysis: GDH and ZZ. Figure design: JYT. Supervision:DL, JRY and QH.
Compliance with ethical standards
Conflict of interest
There is no conflict of interest to disclose among all authors.
All procedures performed in studies were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards, and with the ethical standards of the institutional and national research committee.
The SEER database is an open database and information of patients was anonymous in the SEER database, so the current study do not require patients’ consent.