Mp36-19 Development and Validation of a Novel Nomogram to Predict Lymph Node Invasion in Upper Tract Urothelial Carcinoma

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP36)1 May 2024MP36-19 DEVELOPMENT AND VALIDATION OF A NOVEL NOMOGRAM TO PREDICT LYMPH NODE INVASION IN UPPER TRACT UROTHELIAL CARCINOMA Cesare Saitta, Margaret F. Meagher, Riccardo Autorino, Jonathan A. Afari, Mimi V. Nguyen, Kevin Hakimi, Clara Cerrato, Nicolò M. Buffi, Francesco Porpiglia, Giovanni Lughezzani, Paolo Casale, Giuseppe Simone, Gabriele Tuderti, Chandru Sundaram, Vitaly Margulis, Firas Abdollah, Matteo Ferro, Hooman Djaladat, Reza Mehrazin, Mark Gonzalgo, Zhenjie Wu, Daniel Eun, and Ithaar H. Derweesh Cesare SaittaCesare Saitta , Margaret F. MeagherMargaret F. Meagher , Riccardo AutorinoRiccardo Autorino , Jonathan A. AfariJonathan A. Afari , Mimi V. NguyenMimi V. Nguyen , Kevin HakimiKevin Hakimi , Clara CerratoClara Cerrato , Nicolò M. BuffiNicolò M. Buffi , Francesco PorpigliaFrancesco Porpiglia , Giovanni LughezzaniGiovanni Lughezzani , Paolo CasalePaolo Casale , Giuseppe SimoneGiuseppe Simone , Gabriele TudertiGabriele Tuderti , Chandru SundaramChandru Sundaram , Vitaly MargulisVitaly Margulis , Firas AbdollahFiras Abdollah , Matteo FerroMatteo Ferro , Hooman DjaladatHooman Djaladat , Reza MehrazinReza Mehrazin , Mark GonzalgoMark Gonzalgo , Zhenjie WuZhenjie Wu , Daniel EunDaniel Eun , and Ithaar H. DerweeshIthaar H. Derweesh View All Author Informationhttps://doi.org/10.1097/01.JU.0001008612.93052.9d.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 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. 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 1). 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 nodes 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. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e599 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Cesare Saitta More articles by this author Margaret F. Meagher More articles by this author Riccardo Autorino More articles by this author Jonathan A. Afari More articles by this author Mimi V. Nguyen More articles by this author Kevin Hakimi More articles by this author Clara Cerrato More articles by this author Nicolò M. Buffi More articles by this author Francesco Porpiglia More articles by this author Giovanni Lughezzani More articles by this author Paolo Casale More articles by this author Giuseppe Simone More articles by this author Gabriele Tuderti More articles by this author Chandru Sundaram More articles by this author Vitaly Margulis More articles by this author Firas Abdollah More articles by this author Matteo Ferro More articles by this author Hooman Djaladat More articles by this author Reza Mehrazin More articles by this author Mark Gonzalgo More articles by this author Zhenjie Wu More articles by this author Daniel Eun More articles by this author Ithaar H. Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...