Prognostic nomogram for overall survival in upper urinary tract urothelial carcinoma (UTUC) patients treated with chemotherapy: a SEER-based retrospective cohort study

Abstract

Objective To establish a prognostic nomogram among UTUC patients who received chemotherapy. Methods 1195 UTUC patients who received chemotherapy were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for the period between 2004 and 2015. Patients were randomly divided into a training and a validation set. Nomogram was constructed to predict 1-, 3-, and 5-year overall survival (OS) in those patients. Receiver-operating characteristic curves (ROCs), calibration plots, and Decision curve analysis (DCA) were applied to assess and compare the discrimination, accuracy, and practicability of the nomogram with 8th American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging system. Results Six clinical parameters were identified as independent prognostic factors for UTUC patients’ OS, including age, marital status, TNM stage, and surgical methods of the primary site. The ROC curves showed a satisfactory discrimination capacity of the nomogram, with 1-, 3-, and 5-year area under curve (AUC) values of 0.789, 0.772, and 0.763 in the training set and 0.772, 0.822, and 0.814 in the validation set, respectively. Calibration curves indicated a good agreement between actual observation and nomogram prediction. ROC and DCA curves showed our nomograms exhibited larger benefits than the 8th AJCC-TNM staging system. Conclusions A prognostic nomogram was established and validated to present individual predictions of OS among chemotherapeutic UTUC patients. This nomogram may assist clinicians in accurate survival prognostication, treatment decision-making, and design of future clinical trials.

Management of Upper Tract Urothelial Carcinoma in a Double Collecting System Kidney

“…The 5-year cancer-specific survival (CSS) in non-muscle-invasive UTUC is 86%, while for muscle-invasive disease, it is 70%. About 9% of patients present with metastatic disease, with a CSS of 39% [75,76]. Our patient was considered a suitable candidate for this surgery, benefiting from a favorable prognostic profile at the initial presentation.…”

Upper Tract Urothelial Carcinoma (UTUC) Diagnosis and Risk Stratification: A Comprehensive Review

“…Another meta-analysis on post-operative nomograms revealed a significant negative predictive value of age for CSS [1]. Although several studies have shown the association between age and survival indices [43,44], no association was found after adjustment for performance status (PS) [45]. However, age is found to be a predictor of muscle-invasive disease [46][47][48][49].…”

“…The AUC values of 78.9%, 77.2%, and 76.3% show discrimination accuracy of their nomogram for 1-, 3-, and 5-year OS in the development cohort. Their internally validated nomogram showed superior accuracy compared to the American Joint Committee on Cancer (AJCC)-TNM staging system [44].…”