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Comparison of different prediction tools for the risk of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma: a propensity-matched analysis

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Abstract

Objective

To compare the predictive performance of the current clinical prediction models for predicting intravesical recurrence (IVR) after radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC).

Methods

We retrospectively analysed upper tract urothelial carcinoma patients who underwent radical nephroureterectomy in our centre from January 2009 to December 2019. We used the propensity score matching (PSM) method to adjust the confounders between the IVR and non-IVR groups. Additionally, Xylinas’ reduce model and full model, Zhang’s model, and Ishioka’s risk stratification model were used to retrospectively calculate predictions for each patient. Receiver operating characteristic (ROC) curves were generated, and the areas under the curves (AUCs) were compared to identify the method with the highest predictive value.

Results

We included 217 patients with a median follow-up of 41 months, of which 57 had IVR. After PSM analysis, 52 pairs of well-matched patients were included in the comparative study. No significant difference was found in clinical indicators besides hydronephrosis. The model comparison showed that the AUCs of the reduced Xylinas’ model for 12 months, 24 months, and 36 months were 0.69, 0.73, and 0.74, respectively, and those of the full Xylinas’ model were 0.72, 0.75, and 0.74, respectively. The AUC of Zhang’s model for 12 months, 24 months, and 36 months was 0.63, 0.71, and 0.71, respectively, the performance of Ishioka’s model is that the AUC of 12 months, 24 months and 36 months was 0.66, 0.71, and 0.74, respectively.

Conclusion

The external verification results of the four models show that more comprehensive data and a larger sample size of patients are needed to strengthen the models’ derivation and updating procedure, to better apply them to different populations.

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Data availability

All the data were presented in the manuscript. No additional data are available.

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. No conflict of interest relevant to this manuscript are reported for all authors.

Author information

Author notes

  1. Zhenkai Luo, Binbin Jiao and Hang Zhao contributed to the work equally and should be regarded as co-first authors.

Authors and Affiliations

  1. Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, No. 17 Nanli, Panjiayuan, Chaoyang District, Beijing, 100730, China

    Zhenkai Luo

  2. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Nanli, Panjiayuan, Chaoyang District, Beijing, 100021, China

    Zhenkai Luo

  3. Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China

    Binbin Jiao

  4. Peking University China-Japan Friendship School of Clinical Medicine, Yinghuadong Road, Chaoyang District, Beijing, 100029, China

    Hang Zhao, Yuhao Liu, Haijie Chen & Yunfan Guan

  5. Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing, 100029, China

    Hang Zhao, Yuhao Liu, Haijie Chen, Yunfan Guan & Guan Zhang

  6. Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, China

    Tao Huang

  7. Department of Urology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, China

    Zhaoqiang Jiang

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Contributions

BJ, ZL conceived of the presented idea. BJ, ZL and HZ developed the theory and performed the computations. TH, YL, HC and HZ verified the underlying data. YL, HC and YG collected the data, ZD and GZ supervise this study. All authors discussed the results and contributed to the final manuscript.

Corresponding authors

Correspondence to Guan Zhang or Zhaoqiang Jiang.

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Conflict of interest

The authors have fully disclosed their conflicts of interest in the manuscript and during the submission process. This manuscript has not been published and is not under consideration for publication elsewhere.

Ethical approval (Research involving human participants and/or animals)

This study was approved by the institutional research ethics committee of China-Japan Friendship Hospital (reference: 2021-40-K24) and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Written informed consent was obtained from the patients included in the study prior to its publication.

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Luo, Z., Jiao, B., Zhao, H. et al. Comparison of different prediction tools for the risk of intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma: a propensity-matched analysis. Clin Transl Oncol 26, 136–146 (2024). https://doi.org/10.1007/s12094-023-03226-1

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