BACKGROUND: Several groups have proposed features to identify low-risk patients who may benefit from endoscopic kidney-sparing surgery in upper tract urothelial carcinoma (UTUC). OBJECTIVE: To evaluate standard risk stratification features, develop an optimal model to identify ≥pT2/N+ stage at radical nephroureterectomy (RNU), and compare it with the existing unvalidated models. DESIGN, SETTING, AND PARTICIPANTS: This was a collaborative retrospective study that included 1214 patients who underwent ureterorenoscopy with biopsy followed by RNU for nonmetastatic UTUC between 2000 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We performed multiple imputation of chained equations for missing data and multivariable logistic regression analysis with a stepwise selection algorithm to create the optimal predictive model. The area under the curve and a decision curve analysis were used to compare the models. RESULTS AND LIMITATIONS: Overall, 659 (54.3%) and 555 (45.7%) patients had ≤pT1N0/Nx and ≥pT2/N+ disease, respectively. In the multivariable logistic regression analysis of our model, age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.0-1.03, p = 0.013), high-grade biopsy (OR 1.81, 95% CI 1.37-2.40, p < 0.001), biopsy cT1+ staging (OR 3.23, 95% CI 1.93-5.41, p < 0.001), preoperative hydronephrosis (OR 1.37 95% CI 1.04-1.80, p = 0.024), tumor size (OR 1.09, 95% CI 1.01-1.17, p = 0.029), invasion on imaging (OR 5.10, 95% CI 3.32-7.81, p < 0.001), and sessile architecture (OR 2.31, 95% CI 1.58-3.36, p < 0.001) were significantly associated with ≥pT2/pN+ disease. Compared with the existing models, our model had the highest performance accuracy (75% vs 66-71%) and an additional clinical net reduction (four per 100 patients). CONCLUSIONS: Our proposed risk-stratification model predicts the risk of harboring ≥pT2/N+ UTUC with reliable accuracy and a clinical net benefit outperforming the current risk-stratification models. PATIENT SUMMARY: We developed a risk stratification model to better identify patients for endoscopic kidney-sparing surgery in upper tract urothelial carcinoma.

Brady Urological Institute and Department of Urology Johns Hopkins Medicine Baltimore MD USA

Department of Genitourinary Oncology Moffitt Cancer Center Tampa FL USA

Department of Genitourinary Oncology Moffitt Cancer Center Tampa FL USA; Department of Surgery Division of Urology Hôpital du Sacré Coeur de Montréal University of Montreal Quebec Canada

Department of Urology Bichat Claude Bernard Hospital Assistance Publique Hôpitaux de Paris Paris Descartes University Paris France

Department of Urology Careggi Hospital University of Florence Florence Italy

Department of Urology Jagiellonian University Medical College Krakow Poland

Department of Urology Jikei University School of Medicine Tokyo Japan

Department of Urology Kaohsiung Medical University Hospital Kaohsiung Taiwan; Department of Urology School of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan

Department of Urology MD Anderson Cancer Center Houston TX USA

Department of Urology MD Anderson Cancer Center Houston TX USA; Department of Urology and Kidney Transplant The University of Toledo Medical Center and Eleanor N Dana Cancer Center Toledo OH USA

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology Medical University of Vienna Vienna Austria; Department of Urology Kantonsspital Winterthur Winterthur Switzerland

Department of Urology Medical University of Vienna Vienna Austria; Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan

Department of Urology Medical University of Vienna Vienna Austria; Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman Jordan; Department of Urology University of Texas Southwestern Medical Center Dallas TX USA; Department of Urology Weill Cornell Medical College New York NY USA; Karl Landsteiner Institute of Urology and Andrology Vienna Austria; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic; Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia

Department of Urology Medical University of Vienna Vienna Austria; Division of Urology Department of Surgical Sciences University of Torino School of Medicine Turin Italy

Department of Urology Provincial Hospital of Bozen Bozen Italy; Medical School Sigmund Freud University Vienna Austria

Department of Urology Seoul National University Hospital Seoul Korea

Department of Urology The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Department of Urology University Hospitals Leuven Leuven Belgium

Department of Urology University of Rennes Rennes France

Department of Urology University of Texas Southwestern Medical Center Dallas TX USA

Department of Urology University of Texas Southwestern Medical Center Dallas TX USA; Department of Urology University Hospital Muenster Muenster Germany

Department of Urology Uro Oncology University Hospital Cologne Cologne Germany

Division of Oncology Unit of Urology URI IRCCS Ospedale San Raffaele Vita Salute San Raffaele University Milan Italy

Division of Oncology Unit of Urology URI IRCCS Ospedale San Raffaele Vita Salute San Raffaele University Milan Italy; Department of Urology Luzerner Kantonsspital Lucerne Switzerland

Division of Urology McGill University Health Center McGill University Montreal Canada

Division of Urology McGill University Health Center McGill University Montreal Canada; Urology Department Claude Huriez Hospital CHU Lille Lille France

Division of Urology VCU Health Richmond VA USA

Instituto Valenciano de Oncologia Foundation Valencia Spain

Urology GRC 5 Predictive ONCO URO Pitié Salpêtrière Hospital AP HP Sorbonne University Paris France

Eur Urol. 2022 Apr;81(4):428-429. doi: 10.1016/j.eururo.2022.01.013. PubMed

Citace poskytuje Crossref.org

Need for and extent of lymph node dissection for upper tract urothelial carcinoma: an updated review in 2023