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Combining imaging and ureteroscopy variables in a preoperative multivariable model for prediction of muscle‐invasive and non‐organ confined disease in patients with upper tract urothelial carcinoma
Author(s) -
Favaretto Ricardo L.,
Shariat Shahrokh F.,
Savage Caroline,
Godoy Guilherme,
Chade Daher C.,
Kaag Matthew,
Bochner Bernard H.,
Coleman Jonathan,
Dalbagni Guido
Publication year - 2012
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2011.10288.x
Subject(s) - ureteroscopy , urothelial carcinoma , medicine , disease , ureter , urology , multivariable calculus , radiology , cancer , bladder cancer , control engineering , engineering
Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Improved patient selection for conservative management, neoadjuvant chemotherapy, and/or extended lymphadenectomy is urgently needed. We developed a highly accurate preoperative model to predict muscle‐invasive and non‐organ‐confined upper tract urothelial carcinoma based on standard imaging and ureteroscopy features. OBJECTIVE • To create a preoperative multivariable model to identify patients at risk of muscle‐invasive (pT2+) upper tract urothelial carcinoma (UTUC) and/or non‐organ confined (pT3+ or N+) UTUC (NOC‐UTUC) who potentially could benefit from radical nephroureterectomy (RNU), neoadjuvant chemotherapy and/or an extended lymph node dissection. PATIENTS AND METHODS • We retrospectively analysed data from 324 consecutive patients treated with RNU between 1995 and 2008 at a tertiary cancer centre. • Patients with muscle‐invasive bladder cancer were excluded, resulting in 274 patients for analysis. • Logistic regression models were used to predict pT2+ and NOC‐UTUC. Pre‐specified predictors included local invasion (i.e. parenchymal, renal sinus fat, or periureteric) on imaging, hydronephrosis on imaging, high‐grade tumours on ureteroscopy, and tumour location on ureteroscopy. • Predictive accuracy was measured by the area under the curve (AUC). RESULTS • The median follow‐up for patients without disease recurrence or death was 4.2 years. • Overall, 49% of the patients had pT2+, and 30% had NOC‐UTUC at the time of RNU. • In the multivariable analysis, only local invasion on imaging and ureteroscopy high grade were significantly associated with pathological stage. • AUC to predict pT2+ and NOC‐UTUC were 0.71 and 0.70, respectively. CONCLUSIONS • We designed a preoperative prediction model for pT2+ and NOC‐UTUC, based on readily available imaging and ureteroscopic grade. • Further research is needed to determine whether use of this prediction model to select patients for conservative management vs RNU, neoadjuvant chemotherapy, and/or extended lymphadenectomy will improve patient outcomes.