Development and validation of a novel nomogram to predict lymph node invasion in upper tract urothelial carcinoma
Recommended Citation
Saitta C, Meagher MF, Autorino R, Porpiglia F, Bell S, Abdollah F, Simone G, Yong C, Lughezzani G, Afari J, Tozzi M, Jacob T, Ghoreifi A, Wang L, Margulis V, Sundaram C, Djaladat H, Mehrazin R, Gonzalgo M, Buffi NM, Wu Z, Ferro M, Derweesh I. Development and validation of a novel nomogram to predict lymph node invasion in upper tract urothelial carcinoma. Eur Urol 2024; 85:S716-S717.
Document Type
Conference Proceeding
Publication Date
3-1-2024
Publication Title
Eur Urol
Abstract
Introduction & Objectives: The role of lymphadenectomy in upper tract urothelial carcinoma (UTUC) remains controversial. We sought to develop a preoperative nomogram capable to predict nodal tropism (NT) defined as nodes invasion at the histological report (NI) or presence of nodes metastasis (NM) at follow up. Materials & Methods: We conducted a retrospective analysis of the ROBUUST database for UTUC patients who underwent robotic nephroureterectomy. NI was defined as presence of positive nodes at final histological report, while NM was defined as the emergence of newly detected retroperitoneal lymphadenopathy (>10 mm) during the follow-up period. Patients who underwent neoadjuvant or adjuvant chemotherapy were excluded from analysis. Primary objective was to develop a predictive model for NT. The model was developed through a stepwise multivariable logistic regression (MLR). Secondary outcomes pertain to internal validation through cross validation analysis. Accuracy of the model was tested with receiver operator characteristic/area under the curve (AUC). Results: 1,117 were analyzed [755 (64.1%) male and 422 (35.8%) female]. On MLR cN+ [Odds ratio(OR) 8.19, p<0.001] cT4 vs cTa (OR 10.38, p=0.012), history of bladder cancer (OR 6.66, p<0.001), high-grade cytology (OR 2.90, p<0.001), platelets lymphocyte ratio≥130 (OR 1.77, p=0.021), diabetes mellitus (OR 1.90, p=0.023), and symptoms at diagnosis (OR 2.16, p=0.008) were independent predictors for NT. A nomogram was developed based on the MVL (Figure). AUC of the model was 0.83. AUC after internal validation was 0.81 (95% confidence interval 0.76-0.87). A 7% threshold probability demonstrated 80.2% sensitivity, 75.4% specificity and 97.5% negative predictive value. Conclusions: We designed and internally validated a novel nomogram integrating patient characteristics and serum biomarkers to predict lymph node involvement and progression in UTUC. Further investigation is requisite to evaluate utility with respect to the performance of lymphadenectomy at the time of surgery, post-surgical monitoring, and refinement of selection of patients for adjuvant and neoadjuvant therapy. [Figure presented]
Volume
85
First Page
S716
Last Page
S717
