Mp38-05 Head-to-Head Comparison of the American Urological Association and European Association of Urology Risk Stratification Models of Upper Tract Urothelial Carcinoma

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma II (MP38)1 May 2024MP38-05 HEAD-TO-HEAD COMPARISON OF THE AMERICAN UROLOGICAL ASSOCIATION AND EUROPEAN ASSOCIATION OF UROLOGY RISK STRATIFICATION MODELS OF UPPER TRACT UROTHELIAL CARCINOMA Andrea Gallioli, Giuseppe Basile, Josep Maria Gaya, Angelo Territo, Alessio Pecoraro, Camille Berquin, Isabel Sanz-Gomez, Francesco Sanguedolce, Marta Casadevall, Luca Afferi, Jorge Huguet, Joan Palou, and Alberto Breda Andrea GallioliAndrea Gallioli , Giuseppe BasileGiuseppe Basile , Josep Maria GayaJosep Maria Gaya , Angelo TerritoAngelo Territo , Alessio PecoraroAlessio Pecoraro , Camille BerquinCamille Berquin , Isabel Sanz-GomezIsabel Sanz-Gomez , Francesco SanguedolceFrancesco Sanguedolce , Marta CasadevallMarta Casadevall , Luca AfferiLuca Afferi , Jorge HuguetJorge Huguet , Joan PalouJoan Palou , and Alberto BredaAlberto Breda View All Author Informationhttps://doi.org/10.1097/01.JU.0001008700.92603.b1.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The European Association of Urology (EAU) and the American Urological Association (AUA) developed separate risk stratification models to guide the treatment selection process of patients with upper tract urothelial carcinoma (UTUC). Herein we performed a head-to-head comparison between the EAU and AUA risk models in predicting oncological outcomes after conservative treatment of UTUC. METHODS: We relied on a prospectively maintained database of patients who underwent conservative treatment for UTUC at our tertiary care institution, between 2015-2022. First, we categorized patients into low-risk (LR) and high-risk (HR) subgroups according to AUA and EAU models. Second, Kaplan-Meir curves estimated the 2-yr UTUC recurrence-free survival (RFS) and clinical progression (CP) defined as upgrading, upstaging or metastatic progression in LR and HR patients according to AUA and EAU models and differences between curves were evaluated with the log-rank test. The discriminative ability of the models in predicting oncological outcomes was assessed using Harrell's concordance index (c-index). Finally, decision-curve analysis (DCA) was used to evaluate the net benefit of the predictive models. RESULTS: In total, 165 (65%) and 88 (35%) patients were categorized as LR and HR by the AUA model, respectively. Conversely, 124 (49%) and 129 (51%) were LR and HR according to EAU model, respectively. The median follow-up was 27 (IQR: 10-42) months. Overall, 55 (33%) vs 18 (15%) LR patients and 44 (50%) vs 81 (63%) HR patients were submitted to radical nephroureterectomy in the AUA and EAU groups, respectively. The estimated 2-yr RFS rates were 58% (95%CI 51-67) vs 45% (95%CI 35-57) in LR vs HR (p=0.007) for the AUA model (c-index: 0.56), and 79% (95%CI 71-87) vs 32% (95%CI 25-42) in LR vs HR (p<0.001) for the EAU model (c-index:0.72). Net benefits were achieved for threshold probabilities higher than 20% and 40% for the EAU and AUA models, respectively. The estimated 2-yr CP rates were 79% (95%CI 72-87) vs 71% (95%CI 60-84) in LR vs HR (p=0.1) for the AUA model (c-index: 0.55), and 86% (95%CI 78-94) vs 65% (95%CI 55-76) in LR vs HR (p<0.001) for the EAU model (c-index:0.66). The DCA showed a superior net benefit for the EAU model compared to the AUA model in predicting UTUC recurrence and CP between risk classes. CONCLUSIONS: Although both the AUA and EAU risk stratification models are able to stratify patients with high or low risk of disease recurrence and progression after conservative treatment, a non-negligible difference in terms of performance accuracy exists among the models. The EAU risk stratification model showed better discriminative value in predicting clinical events compared to the AUA model. Source of Funding: No © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e642 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Andrea Gallioli More articles by this author Giuseppe Basile More articles by this author Josep Maria Gaya More articles by this author Angelo Territo More articles by this author Alessio Pecoraro More articles by this author Camille Berquin More articles by this author Isabel Sanz-Gomez More articles by this author Francesco Sanguedolce More articles by this author Marta Casadevall More articles by this author Luca Afferi More articles by this author Jorge Huguet More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF downloadLoading ...